Logrea Dance Academy Online Registration

Registration

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Welcome to Logrea Dance Academy! Please complete the following 2022-2023 registration form.

* 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*

Home or 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* (format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

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

NOTE: If you are paying by monthly payment plan. Please indicate how many months you would like to make the payment plan.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

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

NOTE: If you are paying by monthly payment plan. Please indicate how many months you would like to make the payment plan.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

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

NOTE: If you are paying by monthly payment plan. Please indicate how many months you would like to make the payment plan.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

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

NOTE: If you are paying by monthly payment plan. Please indicate how many months you would like to make the payment plan.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

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

NOTE: If you are paying by monthly payment plan. Please indicate how many months you would like to make the payment plan.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment 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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
dance studios , gyms , swim schools , music schools , cheer gyms , childcare centers , and more .

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)