Virginia Regional Ballet Online Registration

Registration

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Please complete the form below. Please Note: Tuition for the 2019-20 dance year will be posted to your account after your class selections have been reviewed by VRB staff. Fee postings may take up to one week to appear on your account.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Contact Information

Family/Account Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Contact #1 First Name*

Last Name *

Relationship to Student*

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

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Relationship to Student*

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Current Grade Level

Disabilites/Limitations, leave blank if none

List Any Allergies, leave blank if none

Use the search button to select classes.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Current Grade Level

Disabilites/Limitations, leave blank if none

List Any Allergies, leave blank if none

Use the search button to select classes.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Current Grade Level

Disabilites/Limitations, leave blank if none

List Any Allergies, leave blank if none

Use the search button to select classes.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Current Grade Level

Disabilites/Limitations, leave blank if none

List Any Allergies, leave blank if none

Use the search button to select classes.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Current Grade Level

Disabilites/Limitations, leave blank if none

List Any Allergies, leave blank if none

Use the search button to select classes.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

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Registration

Referral Information

Family Contact Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

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

Required Policies

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