Danzco Dance Academy Online Registration

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DANZCO. DANCE ACADEMY FALL/SPRING 2019-20 REGISTRATION

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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*

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

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

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*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

The Fall/Spring dance year consists of approximately 10 months beginning in Aug/Sept ending with the Recital in June. The total amount of tuition is based on the number of classes a dancer is enrolled for instruction each week and is divided evenly by 34-36 classes over the course of 10 months. The full tuition amount is due the 1st of each month, regardless of missed classes due to illness, vacation, school holidays or emergency situations.

Enroll in Classes

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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*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

AUTOMATIC DEBITS

READ CAREFULLY! Please be advised that when you register on-line and or use the on-line payment, you automatically enroll in our auto-debit program. By checking the box, you agree and acknowledge posted fees & charges to your account will be automatically withdrawn using the billing information entered on your account.

DECLINED/RETURNED PAYMENT S FOR ANY REASON will incur an automatic $35 charge per incident. After 3 Returns, another form of payment will be required to be on file. On the 5th of the month a $15 late fee may also be charged if account is not paid.

I've read the above and agree.

PAYMENT POLICIES

SUMMER ENROLLMENT: One time fee is collected at the time of enrollment.

FALL/SPRING ENROLLMENT: First & last month's tuition are collected along with an annual registration fee at the time of enrollment. Remaining monthly tuition will be due on the 1st of each month & auto-debited between 1st-3rd of the month.

LATE FEES, $15 are charged on the 5th of the month for past due accounts for any reason. Students may not be permitted to participate in classes or performances nor will costumes be released to any family with an account past due.

MISSED CLASSES BY STUDENT: Fees are not credited for student absences.

PAYMENTS for Tuition, Costumes, Recital & Competition Fees are Non-Refundable/Transferable between dancers. No exceptions please.

I've read the above and agree.

CLASS CHANGES/WITHDRAWALS

NOTE: Schedule changes/transfers/withdrawals can only be processed by Danzco. Staff.

SCHEDULE CHANGES/TRANSFERS: Requires a written notice of the change/transfer & reason to be submitted to the Front Office in person or by email. Final Fall/Spring schedule changes should be completed by December.

CLASS WITHDRAWAL: Requires a written notice of the withdrawal & reason to be submitted to the Front Office in person or by email 30 days in advance of the withdrawal date. Please Note: All paid fees are Non-Refundable/Transferable between dancers. No exceptions please.

STUDIO WITHDRAWAL: Requires a written notice of the withdrawal & reason to be submitted to the Front Office in person or by email 30 days in advance of the withdrawal date. Please Note: All paid fees are Non-Refundable/Transferable between dancers. No exceptions please.

If the withdrawal occurs before the enrollment is processed or the session begins:
Summer Sessions: A $35 processing fee will be posted & collected before the account is moved to Inactive status.
Fall/Spring Session: The annual Registration fee will be posted & collected before the account is moved to Inactive status. The paid Registration fee will remain on the account should the student return during that same dance year.

I've read the above and agree.

RELEASE OF LIABILITY

I understand there is a risk of personal injury with dance, tumbling and cheerleading classes and performances as with any sport. I represent that the above named student is in good health and physically capable of participation in registered classes, performances, including Recital. On behalf of myself,(the above named student, if different than the undersigned), I thereby waive and release any claim against Danzco. Dance Academy, Juanita Sanders, and their staff, contracted or employed, heirs, landlord and contractors arising out of personal injury occuring in connection with classes, performances, or Recitals.

I've read the above and agree.

MEDICAL EMERGENCIES

I, the parent/guardian accept responsibility for obtaining appropriate accident, health, and hospitalization insurance for the student in the event of personal injury. In the event of an injury or other medical emergency if I cannot be reached, I the parent/guardian of the dancer named above, authorize you or a representative of Danzco. Dance Academy to seek any reasonable medical assistance required in your judgement and I agree to be responsible for those medical expenses incurred on behalf of the dancer.

I've read the above and agree.

I Agree to All of the Above

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