Dance Dynamics Studio Online Registration

Registration

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* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Where do you live?

Home Address*

City*

State*

Zip*

Additional Info

Emergency Contact Info

Contact #1

Primary Contact 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

Secondary Contact 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

T-Shirt Size

School*

Grade Level*

Allergies (Leave blank if NONE)

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

T-Shirt Size

School*

Grade Level*

Allergies (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

T-Shirt Size

School*

Grade Level*

Allergies (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

T-Shirt Size

School*

Grade Level*

Allergies (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

T-Shirt Size

School*

Grade Level*

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Release of Liability

Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.
Dance Dynamics LLC cannot prevent you [or your child(ren)] from becoming exposed to, contracting, or spreading COVID-19 while utilizing Dance Dynamics services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize Dance Dynamics services and/or enter onto Dance Dynamics's premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

I've read the above and agree.

Assumption of Risk

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Dance Dynamics's services and enter Dance Dynamics's premises. These services are of such value to me [and/or to my children,] that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Dance Dynamics's services and premises in person rather than joining our alternative method of enjoying the same services virtually. WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against Dance Dynamics LLC and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Dance Dynamics, LLC services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. CHOICE OF LAW: I understand and agree that the law of the State of Georgia will apply to this contract. I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE:

I've read the above and agree.

Payment Policies

PAYMENT POLICIES: I agree to pay all costs incurred with Dance Dynamics. By registering for the upcoming dance season, there will be a $40 re-enrollment fee (1 dancer) each dance season billed to the payment information you put on file. I understand that tuition will be automatically billed at the first of each month or on the first day of summer camps to the card or on file.
COSTUMES: Any costumes will be automatically charged to the card on file based on our policies. I also understand that costume costs are non-refundable. If your dancer quits during the year, and you have paid for your costumes already, we will give them to you as soon as they come in. If you withdraw from dance, we will need a 30 day written notice, and any tuition costs will be charged within that 30 day period.

I've read the above and agree.

Dance Company

Competition and/or convention (for company members) costs will be automatically billed to the card on file approximately 1 month prior to going. If a card expires during the dance year, you must replace it as soon as possible, and if not, your dancer may not be able to dance. Competition and convention costs are nonrefundable.

I've read the above and agree.

Agreement for Participation

I understand that dance classes may include, without limitation, dancing with props, stretching, barre work, across the floor combinations, dance routines in the center, and other related activities. I further understand that all of the activities of the dance class involve some degree of risk of strain or bodily injury. By agreeing to this, all participants' automatically grant permission to Dance Dynamics the use of their image in photos and video for all advertising and publicity purposes. Dance Dynamics Studio is not responsible for personal property.

I have reviewed all of Dance Dynamics policies and understand them thoroughly, including:
*Studio Policies
*Tuition & Payment Policies
*Costume Payments (does not apply to summer camps)
I agree to be responsible for reading studio correspondence and respecting deadlines, if applicable.
I hereby acknowledge that I have read the statements above and agree to participate accordingly.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

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