5678 Dance! Studio LLC Online Registration

Registration

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Welcome to 5678 Dance! Studio LLC! Please complete the following registration form. ALL SCHOOL YEAR CLASSES are divided by age and experience. Please note you must receive class time options directly from us before registering for a class. If you have not received which class times you can register for please email us at 5678danceoconomowoc@gmail.com HARVEST HOEDOWN is open for dancers of all levels ages 3-7.

* 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 *

Type*

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*

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

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Please list any previous dance experience

ALL SCHOOL YEAR CLASSES are divided by age and experience. Please note you must receive class time options directly from us before registering for a class. If you have not received which class times you can register for please email us at 5678danceoconomowoc@gmail.com HARVEST HOEDOWN is open for dancers of all levels ages 3-7.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

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

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Please list any previous dance experience

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

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

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Please list any previous dance experience

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

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

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Please list any previous dance experience

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

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

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Please list any previous dance experience

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

PAYMENT AND FEE POLICY

PAYMENT AND FEE POLICY
SCHOOL YEAR PROGRAM: The 1st month's tuition and a $10.00 family registration fee are charged to your account at the time of registration. Monthly tuition is then due the 1st class of each month. A $5.00 late fee will be assessed after the 15th of each month.
SUMMER/WINTER PROGRAMS: Your full tuition amount will be charged to your account at the time of registration.
HARVEST HOEDOWN: The $25.00 per dancer fee will be charged to your account at the time of registration.
There are no refunds on tuition or registration fees.

I've read the above and agree.

PRIVACY STATEMENT

I agree to notify 5678 Dance! Studio before our 1st class if I do NOT want my child photographed or videotaped for educational or promotional use.

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

Zip*