Dance Dynamics Studio Online Registration

Registration

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Welcome to Dance Dynamics Studio -936 Tungsten Street, Thunder Bay - Please contact us at trevor@tbaytel.net if you have any questions or difficulty registering. All * boxes require information. You must scroll to the bottom of the page to submit your form. Days & Time of some classes still TBD

* 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/Prov*

Postal Code*

Home or Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

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* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School

Disabilities*

Special Needs*

Allergies*

Primary Doctor

OHIP#*

You cannot make your payment directly here, Credit cards on file are processed 1-3 days prior to your first class if payments have not already been received prior.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities*

Special Needs*

Allergies*

Primary Doctor

OHIP#*

You cannot make your payment directly here, Credit cards on file are processed 1-3 days prior to your first class if payments have not already been received prior.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities*

Special Needs*

Allergies*

Primary Doctor

OHIP#*

You cannot make your payment directly here, Credit cards on file are processed 1-3 days prior to your first class if payments have not already been received prior.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities*

Special Needs*

Allergies*

Primary Doctor

OHIP#*

You cannot make your payment directly here, Credit cards on file are processed 1-3 days prior to your first class if payments have not already been received prior.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities*

Special Needs*

Allergies*

Primary Doctor

OHIP#*

You cannot make your payment directly here, Credit cards on file are processed 1-3 days prior to your first class if payments have not already been received prior.

Enroll in Classes

Select Class

Add Another Student