Extensions Dance Company Online Registration

Registration

Already a customer? Click here to login.

Please complete the following registration form. All discounts will be calculated after submitting this form. You will then be redirected to the parent portal to make a payment. Discounts are as follows: Class Discounts: 5% off 2 classes; 10% off 3 classes, 15% off 4 classes, 20% off 5+ classes. Family Discounts: 10% off 2 students 15% off 3 students 20% off 4+ students. Combined discounts will be applied.

* 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

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

T-Shirt Size

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

Class Discounts: 5% off 2 class, 10% off 3 classes, 15% off 4 classes, 20% off 5+ classes

Family Discounts: 10% off 2 students, 15% off 3 students 20% off 4+ students

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

T-Shirt Size

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

Class Discounts: 5% off 2 class, 10% off 3 classes, 15% off 4 classes, 20% off 5+ classes

Family Discounts: 10% off 2 students, 15% off 3 students 20% off 4+ students

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

T-Shirt Size

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

Class Discounts: 5% off 2 class, 10% off 3 classes, 15% off 4 classes, 20% off 5+ classes

Family Discounts: 10% off 2 students, 15% off 3 students 20% off 4+ students

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

T-Shirt Size

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

Class Discounts: 5% off 2 class, 10% off 3 classes, 15% off 4 classes, 20% off 5+ classes

Family Discounts: 10% off 2 students, 15% off 3 students 20% off 4+ students

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

T-Shirt Size

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

Class Discounts: 5% off 2 class, 10% off 3 classes, 15% off 4 classes, 20% off 5+ classes

Family Discounts: 10% off 2 students, 15% off 3 students 20% off 4+ students

Enroll in Classes

Select Class

Add Another Student