5678 Dance! Studio LLC Online Registration

Registration

Already a customer? Click here to login.

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 WINTER/SUMMER SESSION will note age and you can sign up for them regardless of level.

* 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 WINTER/SUMMER SESSION will note age and you can sign up for them regardless of level.

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

(Show-Hide Details)

PAYMENT AND FEE POLICY

I've read the above and agree.

PRIVACY STATEMENT

I've read the above and agree.

COVID-19 SAFETY POLICIES

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*

Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)