Cabot Dance Academy Online Registration

Registration

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Thank you for Registering at Cabot Dance Academy!!

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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 # * 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)

Additional Info

Student Email

School

Grade Level

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

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 (Leave blank if NONE)

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 (Leave blank if NONE)

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 (Leave blank if NONE)

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 (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

In consideration of being permitted to participate in the Cabot Dance Academy program, I hereby, for my heirs, executors, and administrators waive and release any and all claims for damages I may have against Cabot Dance Academy and the individual members thereof, and all of the officers, agent and employees, free suffered by me while participating with or practicing any activity or function of Cabot Dance Academy.

I've read the above and agree.

Medical Emergencies

In case of any emergency medical situation, I give Cabot Dance Academy and employees the right to seek immediate medical attention for the registered child/children and will not hold Cabot Dance Academy or any employee responsible for said action. I accept responsibility for any and all medical expenses incurred if emergency medical attention is required.

I've read the above and agree.

Photography Release

I agree to allow photos taken of my child/children during participation in any activity or function of Cabot Dance Academy to be used in advertising media including print, published and electronic formats now know or later developed. I give permission for myself and/or my child to be photographed or videotaped during classes, competitions, recital or rehearsals by Cabot Dance Academy for use in advertising, social media updates and/or learning tools.

I've read the above and agree.

Payment Policies

Tuition is due the first day of each month. Late fee will be assessed if not paid by the 15th unless other arrangements have been made prior to due date.
Team Installments are due on set dates listed on the TEAM COST SHEET. No Exception.
Acceptable forms of payment are cash, check, and credit card (Visa or Mastercard). A Credit Card will be left on file for all TEAM members.
If an account is sent to collections for non-payment, an automatic 30% Collections Fee will be added to the account balance due.

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*

Membership Type*

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*