Nolte Academy of Dance Online Registration

Registration

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Welcome to the Nolte Academy and Open Doors Dance Festival registration! Whether you're a beginner or an experienced performer, you're in the right place. Please complete the online registration form for your family. Please note our online system does not accept credit cards and will require banking information. If you wish to use a credit card for automatic payment, please call or stop in to our studio. Questions? Contact us at frontdesk@nolteacademy.com or 319-688-9289.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Prefer Automatic ACH on (Y/N)*

Prefer Automatic CC (Y/N)*

Prefer Walk In Payment (Y/N)*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell # * Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Tuition and Fees

By checking this box I agree that if I enroll in Nolte Academy's 2018-2019 program(s), a non-refundable $25 registration fee per student (or $40 per family) is due at the time of registration and will be automatically debited from my bank account or credit card on file. Monthly class fees are due on the 1st day of month via cash, check or credit card. Any unpaid fees after the 1st day will be automatically deducted from my billing preferences.

I've read the above and agree.

Enrollment Changes/Cancellation

By checking this box, I agree that any cancellation or enrollment changes from a class, camp, or intensive must be communicated to Nolte Academy in writing at least 2 weeks prior to the registered start date. Not informing Nolte Academy of cancellations or changes in enrollment by 2 weeks from the start date will require full payment of the class, camp or intensive.

I've read the above and agree.

Privacy Satement

By checking this box, I give permission to the staff of the Nolte Academy to publish photos and/or videos in which my child appears for the purpose of education, promotion, or publication.

I've read the above and agree.

Medical Eligibility

By checking this box, I certify that the student seeking enrollment has recently undergone a medical examination and has been declared physically fit and able to participate in dance, theatre, or preschool activities by a licensed physician.

I've read the above and agree.

Release of Liability

By checking this box, I agree to adhere to all studio policies and rules of the Nolte Academy of Dance LLC. In consideration of enrollment in these classes, I hereby waive release and discharge any and all claims for damages for personal injury, death and property damage, which may occur to me, my child(ren), family members, estate, heirs(s) or assigns (collectively "My Family"), as a result of participating in the course, practicing or performing instruction, and using the dance studio, any adjacent area, and any property owned or rented by Nolte Academy, including all risk connected therewith, whether foreseen or unforeseen (collectively "dance, theatre and/or preschool activities"). I understand that serious accidents and injuries can occur during these activities, and I agree to indemnify Nolte Academy against loss from any and all further claims, demands, and actions at law or in equity that may hereafter be brought by any member of My Family or anyone on his or her behalf for the purpose of enforcing a claim for damages on account of any injury or damage sustained during any dance, theatre, and/or preschool activities.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

eCheck/Bank Draft

Bank Name *

Account Type *

Your Account Name * (Your name on your bank statement)

Bank Routing Number * (9-digit number)

Account Number *