Registration
Let's dance!!. An introduction class to Ballet, Improve your flexibility. We will learn a little routine that will present to our parents in the last class. Class Dates will be on: Thursday October 17th Thursday October 24th Thursday October 31st Thursday November 7th Thursday November 14th Thursday November 21st
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: *
Emergency Contact Info
 
 
Students entered below will be added to your family's account
 
Questions/Options:
What Grade is your Dancer in? And who is their teacher?*
Dancer's T-shit size*
 
Additional Information:
 
Release of Liability
I hereby release Neisha's Dance & Music Academy, Inc. and its contractors from any claim for damage or suit by reason of injury, illness, or damage to person or property during the course of the dance program. In case of emergency or sudden illness, I hereby five authority to any hospital or doctor to render immediate emergency aid as it might be required for the undersigned student's health and safety. Neisha's Dance & Music Academy, Inc. DOES NOT carry medical insurance for its students. It is required that all students be covered by their own family insurance and if injury occurs, it is understood that the student's own policy is you only source of reimbursement.
I've read the above and agree.
 
Fees
$99 Registration fee includes 6 week session . All sales are final and nonrefundable.
I've read the above and agree.
 
Pick up Preceedure
Please make sure you sign out your dancer with the instructor before you take them home.
I've read the above and agree.
 
Make Ups
One make up can be done per session. Please call our Customer Care desk at (619) 585-1133 to schedule your make up at our Eastlake Location at 870 Jetty Lane, Chula Vista, CA. 91913
I've read the above and agree.
 
Photo Release
I understand and acknowledge that, during the program my child's picture and/or video might be taken while participating in class or function involving ND&MA I do hereby authorize Neisha's Dance & Music Academy to use these photographs or videos for purposes of illustration, advertisement, social media and publication in any manner whatsoever1
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:*