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)

Health Insurance Carrier

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

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)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

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

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

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

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

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

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

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

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Payment Policies

I understand that I am responsible for tuition payments as described. Tuition is non-refundable and is due at the first day of each month. After the tenth of each month, any unpaid tuition will be considered late and will begin to be charged the according late fees

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 employees,
volunteers, and representatives from any and all claims arising from my participation in said classes, activities, studio space and 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 Bobbies 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

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*