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. At least one electronic payment method (bank account or credit card) must be entered. If you have any questions, please 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

Physician

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

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 # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Add Another Student

Required Policies and Agreements

Registration Fee

By checking this box I agree that if I enroll in Nolte Academy's 2019-2020 program(s), a non-refundable registration fee of $25.00 + tax per student is due at the time of registration and will be automatically debited from my bank account or credit card on file.

I've read the above and agree.

Tuition and Fees

By checking this box I agree that my first month's tuition and annual registration fee ($25/individual) will be debited approximately 1-2 weeks from the date of registration. Beginning in October, I acknowledge that monthly payments will be due the first of the month and that payments not received by the 15th of each month will be charged to my payment method on file. If I plan to drop in for payment with cash, check, or card, I agree to do so during the first week of the month.

I also acknowledge that any additional fees (costumes, studio rental, etc.) will be due by the 15th of the month after they are posted to my account. Any unpaid fees after the 15th day will be automatically deducted from my bank account or credit card on file.

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 or drop 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 that month.

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

Account Information

e-Payment Schedule*

Please fill out ONE of the following Payment Methods

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number