West Coast Training Center Online Registration

Registration

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Welcome to WestCoast's online registration! Please provide your information below and click Submit when complete. This registration form should only be filled out if you have a trail class set up, are enrolling into classes, attending private coaching sessions or are attending a special event at our facility that requires you to register with us. If you wish to set up a trial class or have any questions, please refer to our contact page.

* 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*

Do you have a on-line deal or coupon? If so, which one?*

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

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Do you already have a Free Trial Class set up with us? If yes, which class.*

If no, please indicate what you are registering for: Private, B-Day Party, KNO or Special Event.*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Do you already have a Free Trial Class set up with us? If yes, which class.*

If no, please indicate what you are registering for: Private, B-Day Party, KNO or Special Event.*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Do you already have a Free Trial Class set up with us? If yes, which class.*

If no, please indicate what you are registering for: Private, B-Day Party, KNO or Special Event.*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Do you already have a Free Trial Class set up with us? If yes, which class.*

If no, please indicate what you are registering for: Private, B-Day Party, KNO or Special Event.*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Do you already have a Free Trial Class set up with us? If yes, which class.*

If no, please indicate what you are registering for: Private, B-Day Party, KNO or Special Event.*

Add Another Student

Required Policies and Agreements

Assumption of Risk

Waiver & Release: (Please read the entire paragraph below before signing)
I, the undersigned or parent/legal guardian of the individual named above, do hereby waive, release, and forever discharge all claims against WestCoast Training Center (WCTC) for damages, death, personal injury and property damage which may result from attending and participating in classes at WCTC. I understand that accidents can occur in dance and acro/gymnastics activities. Knowing the risks of these activities, I do hereby agree to assume all risks or damages resulting from such activities. By signing this waiver of liability I release and hold harmless WCTC and WCTC instructors, employees and/or the owner from liability. I give WCTC my permission to use photos and videos of the above students for advertising purposes. By enrolling in classes I agree to abide by and adhere to all policies as set forth by WCTC.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

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