Registration
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Welcome to Kanvas Dance Company!
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denotes required fields
Family Information
Family Last Name
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Where do you live?
Home Address
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City
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State
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AK
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DE
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Zip
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Primary Phone
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Additional Info
Emergency Contact Info (Not Contact #1 or #2)
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Contact #1
Contact #1 First Name
*
Last Name
*
Type
*
Caregiver
Father
Grandmother
Guardian
Mother
other
Parent
Self
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
Caregiver
Father
Grandmother
Guardian
Mother
other
Parent
Self
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
*
Additional Info
Student Email
School
Grade Level
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Special Needs
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Agree to Photo Release?
Student #2
(Show-Hide Details)
Student's First Name
*
Last Name
*
Birth Date
*
Additional Info
Student Email
School
Grade Level
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Special Needs
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Agree to Photo Release?
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Birth Date
*
Additional Info
Student Email
School
Grade Level
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Special Needs
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Agree to Photo Release?
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Birth Date
*
Additional Info
Student Email
School
Grade Level
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Special Needs
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Agree to Photo Release?
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Birth Date
*
Additional Info
Student Email
School
Grade Level
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Special Needs
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Agree to Photo Release?
Add Another Student
Required Policies
(Show-Hide Details)
I Agree to All of the Above
Enter your Full Name
*
April 24, 2024
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Card Nickname
Name as it appears on card
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Address Line 1
Address Line 2
City
State
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DE
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HI
IA
ID
IL
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KY
LA
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MD
ME
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NM
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PR
VI
Zip
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eCheck/Bank Draft
Bank Name
Account Type
Checking
Savings
Your Account Name
(Your name on your bank statement)
Bank Routing Number
(9-digit number)
Account Number
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