Spokane Elite Dance Studio Online Registration

Registration

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Welcome to Spokane Elite Dance Studio! We hope to see you in class soon!

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Last Name (of Dancer) Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Contact #1

Primary Contact First Name*

Last Name *

Relationship to Dancer*

How Can We Contact You?

Home Phone

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

Contact #2

Secondary Contact First Name

Last Name

Relationship to Dancer

How can we contact you?

Home Phone

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Once you have submitted your registration you will receive an email confirmation. Please check that you receive that confirmation email to ensure we have the correct contact information for you!

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Once you have submitted your registration you will receive an email confirmation. Please check that you receive that confirmation email to ensure we have the correct contact information for you!

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Once you have submitted your registration you will receive an email confirmation. Please check that you receive that confirmation email to ensure we have the correct contact information for you!

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Once you have submitted your registration you will receive an email confirmation. Please check that you receive that confirmation email to ensure we have the correct contact information for you!

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Once you have submitted your registration you will receive an email confirmation. Please check that you receive that confirmation email to ensure we have the correct contact information for you!

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Participant Agreement

To continue with registration and participate in our services, you must read and accept our Participant Agreement available at this website:

https://sites.google.com/view/seds-participant-agreement/home

By clicking "I've read the above and agree" below, you represent, or represent as the parent or legal guardian of a minor under the age of 18, that you have visited the above website, read, understood and hereby accept the Participant Agreement included therein. You acknowledge you are signing this Agreement electronically, and agree your electronic signature is the legal equivalent of your manual signature.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number