In Motion Dance Studio Online Registration

Registration

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Welcome to In Motion's On-line Registration! Please complete the following registration form to register for a dance class. Payments will be processed using the credit card/bank account you provide.

* 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*

Home or Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

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

Contact #2

Contact #2 First Name

Last Name

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*

Special Needs

Allergies

Primary Doctor

Please click on the Search button below, then choose the class.

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*

Special Needs

Allergies

Primary Doctor

Please click on the Search button below, then choose the class.

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*

Special Needs

Allergies

Primary Doctor

Please click on the Search button below, then choose the class.

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*

Special Needs

Allergies

Primary Doctor

Please click on the Search button below, then choose the class.

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*

Special Needs

Allergies

Primary Doctor

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Liability Release

I realize that dance and dance related activities involves some risks. In consideration of my/my child's participation in these activities, I release and discharge In Motion Dance Studio, Inc. and instructor's from any and all liability arising from accident, injury, and illnesses that my child/myself may suffer as a result of participation in this activity.