North County Academy of Dance Online Registration

Registration

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Welcome to NCAD's online registration! Please provide your information below and click "Submit" when done. Credit Cards are NOT charged at this time.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Last Name*

Where do you live?

Home Address*

City*

State*

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 *

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Primary Doctor Phone#

Please select your classes:

Enroll in Classes

Select Another Class

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Primary Doctor Phone#

Please select your classes:

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

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Primary Doctor Phone#

Please select your classes:

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

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Primary Doctor Phone#

Please select your classes:

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

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Primary Doctor Phone#

Please select your classes:

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Release of Liability

As the legal parent or guardian, I release and hold harmless North County Academy of Dance, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of North County Academy of Dance, its owners and operators or in route to or from any of said premises.

Students/Parents of grant permission to North County Academy of Dance to use student's photos and videos for publicity and advertising purposes, including photos, websites, television, print ads or any video or print broadcasts connected with North County Academy of Dance promotional campaigns.

I've read the above and agree.

Medical Emergency

The undersigned gives permission to North County Academy of Dance, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restictions, or condition and/or declare the paricipant to be in good physical and mental health. I request that our doctor/physician be called and that my child be transported to a hospital.

I've read the above and agree.

Registration Fee

There is a registration fee of $24 due every january. This is pro-rated at $2 per month for new students. (February is $22, March is $20, etc.) You must choose the class Registration in order to post the fee. If you forget to post the fee, it will be added to your account and you will be billed.

I've read the above and agree.

Payment Information

Tuition is due by the first class of each Month. If accounts are paid after the 10th of the month there will be a $20 late fee applied to the account balance. Tuition is the same each month regardless of the number of weeks in the month. (Fifth week classes are free). Each class should receive a minimum of 35 classes throughout the year no matter what day of the week their class is scheduled. There is a $20 returned check charge for any checks returned by your bank. We take cash, credit cards and personal checks. We do not refund tuition or make adjustments for missed classes. Make-up classes are available and expire one month after the missed class. If you would like to drop a class you must notify the directors (not the teacher) at info@northcountyacademyofdance.com or (760) 703-4958 prior to the start of the next month. If you do not drop prior to the 1st of the month you will be charged for the following months tuition.

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