Academy of Movement and Music Online Registration

Registration

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Welcome to The Academy of Movement and Music. The following registration form must be completed by a parent/guardian or student if over 18 years of age.

* 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 (Non-Parent/Guardian) Name & Cell Phone*

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

Academic School

Grade Level

Information about your student you wish to share with Academy staff

Allergies (Type "0" or "None" if none)*

Primary Doctor

Previous Dance Training? Y/N

Prev. Training Where?

Prev. Training How Long?

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

Academic School

Grade Level

Information about your student you wish to share with Academy staff

Allergies (Type "0" or "None" if none)*

Primary Doctor

Previous Dance Training? Y/N

Prev. Training Where?

Prev. Training How Long?

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

Academic School

Grade Level

Information about your student you wish to share with Academy staff

Allergies (Type "0" or "None" if none)*

Primary Doctor

Previous Dance Training? Y/N

Prev. Training Where?

Prev. Training How Long?

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

Academic School

Grade Level

Information about your student you wish to share with Academy staff

Allergies (Type "0" or "None" if none)*

Primary Doctor

Previous Dance Training? Y/N

Prev. Training Where?

Prev. Training How Long?

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

Academic School

Grade Level

Information about your student you wish to share with Academy staff

Allergies (Type "0" or "None" if none)*

Primary Doctor

Previous Dance Training? Y/N

Prev. Training Where?

Prev. Training How Long?

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

Account Information

Auto-Pay on Credit/Debit?*

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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

Required Policies

(Show-Hide Details)