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

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 signing 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 Information
*Dress Code

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.

Payment Policies

I agree to pay all costs incurred with Dance Dynamics. By registering for the upcoming dance season, there will be a $40 registration fee (1 dancer) billed to the payment information you put on file. Dance Dynamics fees include tuition, costumes, and any competitions or conventions your dancer(s) goes to.. I understand that tuition will be automatically billed at the first of each month to the card or bank account on file. Costumes will be automatically charged to the card on file based on our policies. 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. 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. Competition and convention costs are nonrefundable as well. If you withdraw from dance, we wil 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.

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