Dance Dream 3 Studios, LLC Online Registration

Registration

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Loveland Dance (Loveland Location) & Conservatory Dance (Greeley Location) Class Registration Form

* 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

Emergency Contact Info*

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

Who is your employer?

Employer

Employer Phone

Employer Notes

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

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

After you complete the online registration, please visit our front desk to sign a medical/photography release form and set-up your payment arrangements. Official registration in all classes is confirmed after the first class is attended by your dancer. We want to make sure we have the perfect class for each dancer! If you choose to enter your credit card, it will be saved in our system, however NO charges will be posted until you make payment arrangements with front desk staff.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

I am fully aware of the risks or injuries associated with or related to participation in dance classes or performances and I assume all responsibility and such risks in consideration of being allowed to register for classes

I've read the above and agree.

Release of Liability

I release the Dance Dream 3 Studios, their agents, employees successors and assigns, from any and all liability, claims and causes of action by me or my heirs, successors and assigns arising out of or any way related to my participation in or presence at classes, recitals, performances or other events in relation with Dance Dream 3 Studios.

I've read the above and agree.

Payment Policies

All tuition is due by the 1st of each month. A $10 late fee will be assessed on the 5th of the month. Statements are not sent.

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