Dance Dynamics Studio Online Registration

Registration

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This form can be used for Spring /Summer 2018 Programs and the Fall session Be sure to use the Filter options on the left hand side of the Classes to help you find classes you are interested in; Start by filtering the session you are interested in. Once the form is completed be sure to scroll right to the bottom to submit your registration.

* 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 *

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)

Additional Info

School

Grade Level

Disabilites*

Special Needs*

Allergies*

Primary Doctor

Please contact us at trevor@tbaytel.net if you have any questions or difficulty registering You cannot make your payment directly here, only through your authorization upon receipt of your invoice will we process payment to your credit card if you have entered it.

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

School

Grade Level

Disabilites*

Special Needs*

Allergies*

Primary Doctor

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

School

Grade Level

Disabilites*

Special Needs*

Allergies*

Primary Doctor

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

School

Grade Level

Disabilites*

Special Needs*

Allergies*

Primary Doctor

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

School

Grade Level

Disabilites*

Special Needs*

Allergies*

Primary Doctor

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Studio Etiquette

As a studio member, I will respect the staff, dancers, other families of Dance Dynamics Studio, the facilities and all others when attending events outside the studio. I will not discuss other people's children. I will support the efforts of my dancer and her/his classmates. I understand there are progressions to learning and will respect the teacher's knowledge and ability to train my dancer in a safe and appropriate manner. In the event a concern or question arises I will arrange to meet with the teacher/studio director to discuss immediately.

I've read the above and agree.

Payment

Payments of Fees are due on or before the 1st class

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

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/Prov

Postal Code