Mpact Studios Online Registration

Registration

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Welcome to Mpact Studios! Please complete the following registration form. We look forward to dancing with you this season! No tuition will be charged at this time. Tuition fees will be processed on the first day of classes. There will not be a registration fee for summer classes! Thank you for choosing Mpact Studios!

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Type NONE if student does not have any allergies)*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

No tuition will be charged at this time. Tuition fees will be processed on the first day of classes. There will not be a registration fee for summer classes!

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Type NONE if student does not have any allergies)*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

No tuition will be charged at this time. Tuition fees will be processed on the first day of classes. There will not be a registration fee for summer classes!

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Type NONE if student does not have any allergies)*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

No tuition will be charged at this time. Tuition fees will be processed on the first day of classes. There will not be a registration fee for summer classes!

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Type NONE if student does not have any allergies)*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

No tuition will be charged at this time. Tuition fees will be processed on the first day of classes. There will not be a registration fee for summer classes!

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Type NONE if student does not have any allergies)*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

No tuition will be charged at this time. Tuition fees will be processed on the first day of classes. There will not be a registration fee for summer classes!

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

ePayment Schedule *

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

(Show-Hide Details)