Registration
Small Commitment. BIG Fun! Let's have some fun tappin'! . Come to a once a week class . Every Friday from November 1st- November 22nd. We know this might be your dancer's first tap class , so we want to give 25% off on your dancer's first tap shoes.
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
 
Additional Information:
 
Release of Liability
tor 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
$69 Registration fee includes 6 week session . All sales are final and nonrefundable.
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 whatsoever
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:*