Registration
Already a customer? Click here to login.
Join us for a Mothers Day family paint party with Moms, Grandmas, Aunts, and their loving children! Moms, Grandmas, and Aunts will make a 14” x 16” canvas and children will make a 11”x14” canvas, that will all fit together in the end. This event runs 1.5 hours to 2 hours depending on the age of the children involved.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info (Not Contact #1 or #2)
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Years at Dance Connection:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Years at Dance Connection:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Years at Dance Connection:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Years at Dance Connection:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Years at Dance Connection:
Additional Information:
Release of Liability
(Show-Hide Details)
I grant permission to the staff of Dance Connection to take first aid or emergency measures as judged necessary for the care and protection of my child while under the supervision of the studio. In case of medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the emergency unit deems it necessary. I understand that in some medical situations the staff will need to contact the emergency resource before the child’s parent, physician, and or other person acting on the parent’s behalf. I also understand and agree that the child’s parents or legal guardians shall be responsible for any expenses incurred. I agree to hold harmless from any and all liability Dance Connection, its officers, employees and contractors both in their professional capacity and personally for all injury or illness resulting from or in any way connected with his/her participation in the classes, activities or special events at the studio. Parents/legal guardians give their permission to the studio to use photos and or video of their child without remuneration in connection with studio publications, advertising, tv and news coverage. I hereby agree to abide by the price structure indicated above. I understand no further discount or refund will be made for missed classes. I understand that any late payments will be subject to late fees as detailed in the Welcome Packet and Studio Website.I agree to follow the policies and procedures as stated in the Studio Brochure, Welcome Packet, Studio Website, and in all future studio newsletters. I understand that, as the account holder, I will be responsible for any legal or collection fees associated with recovering my account.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
Please Wait...
