RockBallet LLC Online Registration

Registration

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All interested students must fill out this form. When prompted, choose the "WAITLIST/NEW STUDENT" class. The annual registration fee of $45 includes administrative fees, access to the Parent Portal, online payment processing, studio text messaging service, (be sure to" opt in" ) licensing and insurance. You will not be charged the registration fee until you accept a spot in class!

* 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*

Primary Phone*

Additional Info

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

Wanting more than 1 class?*

# of classes you would like?*

Want an extra hip hop class?*

Want an extra ballet class?*

Mom interested in adult class?*

Contact #1

Contact #1 First Name*

Last Name *

Type*

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

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 # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level*

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Interest in a Saturday class?*

Want acrobatic arts/ dance?*

Want a dance fitness class?*

Any prior dance? When & where?*

Prior acro/gymnastics? Where?*

DRESS CODE:

Your student's required CLASS UNFORM will be available for easy online ordering through our online dancewear boutique partner. We have carefully selected items and set this up to be a simple, time saving and affordable process for our families. If you are placed in a class, you will be sent the 2023-2024 season LINK to order your students class uniform online. The link will be sent approximately 3-4 weeks before classes start.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level*

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Interest in a Saturday class?*

Want acrobatic arts/ dance?*

Want a dance fitness class?*

Any prior dance? When & where?*

Prior acro/gymnastics? Where?*

DRESS CODE:

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level*

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Interest in a Saturday class?*

Want acrobatic arts/ dance?*

Want a dance fitness class?*

Any prior dance? When & where?*

Prior acro/gymnastics? Where?*

DRESS CODE:

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level*

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Interest in a Saturday class?*

Want acrobatic arts/ dance?*

Want a dance fitness class?*

Any prior dance? When & where?*

Prior acro/gymnastics? Where?*

DRESS CODE:

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

Grade Level*

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Interest in a Saturday class?*

Want acrobatic arts/ dance?*

Want a dance fitness class?*

Any prior dance? When & where?*

Prior acro/gymnastics? Where?*

DRESS CODE:

Enroll in Classes

Select Class

Add Another Student

Required Policies

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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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
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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)

Who is your employer?

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 (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

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