Melba's Dance School & Shoppe Online Registration

Registration

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Welcome to Melba's Dance School! This is our 62nd year of dance in the Rio Grande Valley. We offer ballet, tap, jazz, hip hop, musical theatre, lyrical, folklorico, bollywood, adult classes, toddler classes, and competitive dance. Additionally have the largest facility in South Texas featuring 7 studios spread over 20,000 sq. feet! Our highly trained staff looks forward to sharing the world of dance with you and your family.

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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 *

Relation to Student*

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

Who is your employer?

Employer*

Employer Phone*

Employer Notes

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*

Who is your employer?

Employer*

Employer Phone*

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies (Leave blank if NONE)

Medications*

Primary Doctor*

Immunization Notes

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

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies (Leave blank if NONE)

Medications*

Primary Doctor*

Immunization Notes

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

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies (Leave blank if NONE)

Medications*

Primary Doctor*

Immunization Notes

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

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies (Leave blank if NONE)

Medications*

Primary Doctor*

Immunization Notes

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

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies (Leave blank if NONE)

Medications*

Primary Doctor*

Immunization Notes

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

Enroll in Classes

Select Class

Add Another Student