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 Name
First Name:* Last Name: *
Type
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info
(Not Contact #1 or #2)
 
 
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:
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I've read the above and agree.
 
Class Poilcies Agreement:
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I've read the above and agree.
 
Liability Release:
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I've read the above and agree.
 
Photo/Video Release:
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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: