Bobbies School of Performing Arts Online Registration

Registration

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Hello and Welcome to Bobbies! Thank you for taking the time to fill out this short registration form. Please arrive 5-10 minutes early and come say hello at the front desk before taking your first class. Please call with any questions. 805 498 7747

* 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 *

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)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Allergies*

Medications

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

School*

Grade Level*

Disabilites

Allergies*

Medications

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

School*

Grade Level*

Disabilites

Allergies*

Medications

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

School*

Grade Level*

Disabilites

Allergies*

Medications

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

School*

Grade Level*

Disabilites

Allergies*

Medications

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Auto Pay

Having your card on file does not constitute automatic payment for tuition. Only those enrolled in Auto Pay, or delinquent after the 19th of the month, will have their card automatically charged. If you are interested in Auto Pay, see the Front Desk for the appropriate release form.

I've read the above and agree.

Payment Policies

I understand that I am responsible for tuition payments as described. Tuition is non-refundable and is due on the first of the month. Tuition is considered delinquent if not paid by the 19th of the month. Tuition not paid by the 19th will be automatically charged to the card on file. (If you are interested in Auto Pay, see the Front Desk.)

I've read the above and agree.

Release

I agree to the physicality of the classes I will be taking, I will assume all risks associated with this activity. I therefore hold harmless Jaime Randall/Farnworth, Bobbie's School of Performing Arts, and all of their staff, volunteers and representatives from any and all claims arising from my participation in said classes, activities, studio space, lobby, including death, personal injury, and a damage to or loss of property. I have read and understand all of the contents of this registration form and agree to the pricing, class policies, and liability release. I further understand that if I am under the age of 18, I must have a parent or legal guardian sign for me.

I've read the above and agree.

Pemission

I hereby give permission to Bobbie's School of Performing Arts to take and use photographs for promotional use.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

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*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number