AKA Dance LLC Online Registration

Registration

Already a customer? Click here to login.

Welcome to AKA Dance!

* 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)*

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Home Phone *

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

Allergies

Please provide your information below and click SAVE when complete. You must supply a valid credit card in order to register.

The class fee amount shown during the registration process is half of the total fee. This amount will be charged to will be charged to your card on file on January 27th. The other half of the total class fee will be charged on March 15th. Recital fees will be charged on February 15th. You may submit class payment during the registration process if you prefer.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

Allergies

Please provide your information below and click SAVE when complete. You must supply a valid credit card in order to register.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

Allergies

Please provide your information below and click SAVE when complete. You must supply a valid credit card in order to register.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

Allergies

Please provide your information below and click SAVE when complete. You must supply a valid credit card in order to register.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

Allergies

Please provide your information below and click SAVE when complete. You must supply a valid credit card in order to register.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

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*

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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)

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

Credit Card

Required Policies

(Show-Hide Details)