East Bay Dance Center Online Registration

Registration

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PLEASE NOTE The class that you selected will appear on the bottom of this registration. You then can add additional classes or weeks to camp. If you need to add more than 5, add the weeks or classes in the comments section. Once you register for a class or camp, we will charge you after any adjustments have been made and you will receive a notice.

* 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*

Health Insurance Carrier

Contact Phone During Program*

Class start date:*

List days for camp (M-F)*

Campers: List food sensitivity

For medical emergency, call:*

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

Disabilites

Special Needs

Allergies*

Medications

Primary Doctor

Skill Notes

Returning Student*

Opt OUT of photo's?

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

Disabilites

Special Needs

Allergies*

Medications

Primary Doctor

Skill Notes

Returning Student*

Opt OUT of photo's?

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

Disabilites

Special Needs

Allergies*

Medications

Primary Doctor

Skill Notes

Returning Student*

Opt OUT of photo's?

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

Disabilites

Special Needs

Allergies*

Medications

Primary Doctor

Skill Notes

Returning Student*

Opt OUT of photo's?

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

Disabilites

Special Needs

Allergies*

Medications

Primary Doctor

Skill Notes

Returning Student*

Opt OUT of photo's?

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Changing Classes and Refunds

I fully understand that tuition is non-refundable. Trial classes are available. Maximum of two trial classes per year per class. The first trial is $10; the second is at single class rate of $16. In the case of a documented medical emergency, a credit may be requested. Credits must be requested prior to missed class or camp and must be made in writing with documentation. A $15 bookkeeping fee will apply to granted credit requests.
I fully understand that any requests to switch classes, camp weeks and pre-paid before and after care must be made in writing 72 hours prior to the beginning of camp or class. I understand I will be charged a $15 bookkeeping fee for each change. There is no charge for a change if the request is from the studio director.