Rhythm & Soul Dance Online Registration

Registration

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Welcome to Rhythm & Soul Dance Co! Please complete the following registration form to register for our 5 week summer session, June 1st-July 2nd. We have TWO locations; 620 & 632 Old Dixie Hwy SW in the Blue Heron Plaza. If you have classes in Studio A or Studio B, you will park and enter through the back of the building. Studio C classes are at the end of the plaza in the 'RSDC" building. You can park and enter through the front. Questions? Email us at Rhythm.soulvb@gmail.com

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Family Information

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Home Address*

City*

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Zip*

Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type*

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Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

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Contact #2

Contact #2 First Name

Last Name

Type

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Cell #

Email (Emails are kept confidential)

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Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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Address Line 1

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Zip*

eCheck/Bank Draft

Bank Name

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Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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Registration

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

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Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

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