Redeeming Dance Academy Online Registration

Welcome to Redeeming Dance Academy! Upon completion of the Registration form you will be directed to the Parent Portal where you will make your class selections for enrollment and enter your billing information. Thanks so much and we are so happy you will be joining us!

* 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)*

Health Insurance Carrier

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*

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (please explain or type in NONE)*

Special Needs (please explain or type in NONE)*

Allergies (please explain or type in NONE)*

Medications (please explain or type in NONE)*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (please explain or type in NONE)*

Special Needs (please explain or type in NONE)*

Allergies (please explain or type in NONE)*

Medications (please explain or type in NONE)*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (please explain or type in NONE)*

Special Needs (please explain or type in NONE)*

Allergies (please explain or type in NONE)*

Medications (please explain or type in NONE)*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (please explain or type in NONE)*

Special Needs (please explain or type in NONE)*

Allergies (please explain or type in NONE)*

Medications (please explain or type in NONE)*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (please explain or type in NONE)*

Special Needs (please explain or type in NONE)*

Allergies (please explain or type in NONE)*

Medications (please explain or type in NONE)*

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

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

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Required Policies

(Show-Hide Details)