NORTH ALABAMA DANCE CENTER Online Registration

Welcome to North Alabama Dance Center! Please complete the following registration form to create your online portal account with Jackrabbit. If you need help or have questions please email NADCdance@gmail.com

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info NAME AND PHONE NUMBER(Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Relation*

How Can We Contact You?

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*

Relationship*

How can we contact you?

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

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Number of Years at NADC*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Number of Years at NADC*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Number of Years at NADC*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Number of Years at NADC*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Number of Years at NADC*

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

How will you pay tuition? Auto-Draft or Self-Pay (still requires card on file)?*

Please fill out ONE of the following Payment Methods

Registration

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

Payment Information

Account Information

Required Policies

(Show-Hide Details)