Lancaster Academy of Performing Arts Online Registration

Registration

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Welcome! PLEASE READ: The form will ask you to input your credit card information. This does NOT charge your card-it simply saves the information for future payments. There is a $25 per student registration fee due upon class enrollment After you register, your account will display your balance. The balance will be INCORRECT. Administration will adjust it to reflect fees, applicable discounts, and any payments you may have already made. We will let you know when your balance is updated

* 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 *

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Relation to Student*

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

Relation to Student

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*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities (Leave BLANK if none or you don't wish to disclose)

Special Needs (Leave BLANK if none, or you don't wish to disclose)

Allergies (Leave BLANK if none, or you don't wish to disclose)

Medications (Leave BLANK if none, or you don't wish to disclose)

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

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities (Leave BLANK if none or you don't wish to disclose)

Special Needs (Leave BLANK if none, or you don't wish to disclose)

Allergies (Leave BLANK if none, or you don't wish to disclose)

Medications (Leave BLANK if none, or you don't wish to disclose)

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

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities (Leave BLANK if none or you don't wish to disclose)

Special Needs (Leave BLANK if none, or you don't wish to disclose)

Allergies (Leave BLANK if none, or you don't wish to disclose)

Medications (Leave BLANK if none, or you don't wish to disclose)

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

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities (Leave BLANK if none or you don't wish to disclose)

Special Needs (Leave BLANK if none, or you don't wish to disclose)

Allergies (Leave BLANK if none, or you don't wish to disclose)

Medications (Leave BLANK if none, or you don't wish to disclose)

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

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities (Leave BLANK if none or you don't wish to disclose)

Special Needs (Leave BLANK if none, or you don't wish to disclose)

Allergies (Leave BLANK if none, or you don't wish to disclose)

Medications (Leave BLANK if none, or you don't wish to disclose)

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

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

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*

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

Credit Card

Required Policies

(Show-Hide Details)