Canadian Dance Company - Burlington Online Registration

Registration

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Welcome to Canadian Dance Company Burlington! In order to register, please fill out all required fields of the registration form including payment information to complete the enrolment process. Once your registration has been approved and payment has been processed you will receive a confirmation email that you are registered for your selected classes providing there are spaces available.

* 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*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Home Phone *

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

School

Grade Level

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

2021 - 2022 Fall Programs run September 13 2021 through June 19 2022. Online Dance With Me and Dancers Conditioning for Adults run on 8 week terms.

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

School

Grade Level

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

2021 - 2022 Fall Programs run September 13 2021 through June 19 2022. Online Dance With Me and Dancers Conditioning for Adults run on 8 week terms.

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

School

Grade Level

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

2021 - 2022 Fall Programs run September 13 2021 through June 19 2022. Online Dance With Me and Dancers Conditioning for Adults run on 8 week terms.

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

School

Grade Level

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

2021 - 2022 Fall Programs run September 13 2021 through June 19 2022. Online Dance With Me and Dancers Conditioning for Adults run on 8 week terms.

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

School

Grade Level

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

2021 - 2022 Fall Programs run September 13 2021 through June 19 2022. Online Dance With Me and Dancers Conditioning for Adults run on 8 week terms.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

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

Country *

City

State*

Zip*

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

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 (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)