Registration
Wellspring Dance Academy is excited to offer our rotating Adult Dance classes for Summer 2018. Please check the complete schedule of summer classes on our website at wellspringdance.org/classes (subject to change). Important Notes: Payment must be received before you can participate in class. Classes will be canceled if less than three (3) people are registered for a given class. A refund will be processed if class is canceled due to low enrollment.
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
 
 
Students entered below will be added to your family's account
 
Questions/Options:
What lead you to register for this summer class/pass?
Have you participated in classes at Wellspring Dance Academy previously?*
If so, how recently?
Did you know that Wellspring Dance Academy offers Adult classes year round? *
What other types of classes would you like to see the Wellspring Dance Academy offer?
 
Additional Information:
 
Registration and Payment Policies Agreement:
- Wellspring Dance Academy reserves the right to cancel any class with insufficient registration and offers a refund for any cancelled classes that have not occurred.
- Payments are due prior to the start of class or student will not be permitted to participate.
- Payments may be made through the parent portal, at the office, or by mail by Visa, MasterCard, Cash, or Check.
- I understand that my enrollment is not complete until Wellspring has reviewed my registration and received my payment.

I've read the above and agree.
 
Class Poilcies Agreement:
-No dangling jewelry (necklaces, bracelets, long earrings) may be worn during class.
-No chewing gum, candy, food, or beverage (other than water) is allowed in the Wellspring Theater.
-Students must attend class and perform in concerts barefoot. Socks may be worn only at the beginning of class during warm-up. Footed tights are dangerous to dance in and may not be worn at any time.
-Students who exhibit repeated negative or disrespectful behavior may be asked to no longer participate in Wellspring classes.
-Student enrollment in class will not be guaranteed until the class fee is received.
-Please contact Wellspring at 269-342-4354 with any questions or concerns you have about classes.
-Class cancellations will be emailed to you and posted on our Facebook page.

I've read the above and agree.
 
Liability Release:
I confirm my understanding that participation in dance classes carries with it a reasonable assumption of risk. Wellspring/Cori Terry & Dancers and its instructors are not liable for personal injuries.
I've read the above and agree.
 
Photo/Video Release:
I grant permission to Wellspring/Cori Terry & Dancers to use performance and in-class photos and video images for promotional purposes. This helps Wellspring create meaningful, authentic promotional pieces.
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number:  
Name as it appears on card:
Nickname:
Card Expiration Month:   Exp Year:
Address Line 1: Address Line 2:
City: State: Zip: