Rockin' Horse Dance Barn Online Registration

Registration

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Welcome. If you have ANY questions call 425-255-9211.

Family Name is your LAST name. It is not necessary to have more than 1 contact
Each registration is meant for just you & your significant other and/or dependents
If you are setting up a group of people you should setup a different Family for each couple in your group. (This allows them to Enroll on their own in the future)
If you want to pay for a group with one Payment please call

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Information

Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

Referred by

If you are registering more than one person be sure to enter their name in the STUDENT #2 drop-down below and choose a class for them. Don't forget to hit SUBMIT after you enter your Credit Card or Checking Account information.

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 #

Additional Info

Student Email

Referred by

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 #

Additional Info

Student Email

Referred by

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 #

Additional Info

Student Email

Referred by

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 #

Additional Info

Student Email

Referred by

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Discounts/Vouchers, Holidays & Makeups

If you qualify for a discount our staff will deduct it before your Credit Card is charged.
If you have a voucher please use the COMMENT section near the bottom of this form and enter where you purchased it, the date and the Voucher number. It is not necessary to enter any other payment info if you have a paid Voucher.

Holidays are posted on the Wall Calendars, Paper Flyer Calendars and the Website. Stay informed by checking these. It is the student's responsibility to follow up and stay informed with studio current events. Regular email reminders are sent to those who give us email addresses. There are no class make-ups or refunds.
Exception: when class is cancelled by the Rockin' Horse Dance Barn, LLC.

I've read the above and agree.

Risk & Liability & Medical Emergencies

In Consideration of participating in classes at the Rockin' Horse Dance Barn, LLC, I understand there are certain risks of injury, and I am willing to assume these risks. I hereby certify that I am capable of participating in the activities of the Rockin' Horse Dance Barn, LLC and I am healthy and have no physical or mental disabilities or infirmities that would restrict full participation in dance activities except as listed below. I hereby waive, release, hold harmless and covenant not to sue the Rockin' Horse Dance Barn, LLC, its officers, employees and other representatives, for all claims made on account of an injury suffered in the normal course of dancing, whether the result of negligence or any other cause.

I hereby release the Rockin' Horse Dance Barn, LLC 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, including special events, and transportation to and from such events.

In case of emergency or sudden illness, I hereby give authority to any Hospital or Doctor to render immediate emergency aid as it might be required for the undersigned student's health and safety.
The Rockin' Horse Dance Barn, LLC 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 students own policy is your only source of reimbursement.

I've read the above and agree.

Class Levels, Staff, Attire & Protocols

For student safety and enjoyment, dancers are only permitted to register and attend classes at the level that the Rockin' Horse Dance Barn, LLC staff places them in. No student may promote themselves into a higher level. Staff is subject to change without notice.

Dance Attire is recommended for all dance classes. This enables the students body movements for correct form and technique. Dance shoes should only be worn inside the studio. Street shoes are not permitted on the dance floor. Please see our Frequently Asked Questions page on our website under the CLASSES PAGE. PHOTOS: I understand and acknowledge that, from time to time throughout the year, my picture might be taken while participating in dance classes and/or functions involving the Rockin' Horse Dance Barn, LLC . I do hereby authorize the Rockin' Horse Dance Barn, LLC to use these photographs for the purposes of illustration, advertisement and publication.
FOOD POLICY: No food or drinks in the dance floor area.
The Rockin' Horse Dance Barn, LLC IS NOT RESPONSIBLE FOR PERSONAL ITEMS LOST, STOLEN, OR DAMAGED. DO NOT LEAVE PERSONAL ITEMS UNATTENDED.
The Rockin' Horse Dance Barn, LLC RESERVES THE RIGHT TO REFUSE YOUR BUSINESS WITHOUT NOTICE.
IN ORDER TO CONTINUE TO PROVIDE A POSITIVE INSPIRATIONAL ATMOSPHERE FOR OUR STUDENTS, WE ASK THAT THERE BE NO GOSSIP IN THE STUDIO. ALL ADULT CONVERSATIONS SHOULD BE RATED "G". RHDB TEACHERS AND STAFF ARE TRAINED PROFESSIONALS. WHEN YOU ATTEND RHDB, WE ASK THAT YOU TRUST IN US. IF YOU HAVE PROGRAM OR PROTOCOL CONCERNS, PLEASE CALL OUR STUDIO MANAGER AT 425-255-9211

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

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