Artistry Dance Project Online Registration

Registration

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Welcome to Artistry Dance Project's easy and convenient Online Registration! Please provide your information below and click Submit when you are complete. Credit Cards will NOT be charged at this time. After completion, please log in to your customer portal from the Artistry Dance Project Home Page. Enter your email address and click the blue link "I don't have a password." You will automatically be sent a password. We suggest immediately changing this to something you will remember.

* 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 #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

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

T-Shirt Size

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

The maximum number of classes to register for on this form is 5. Should you want to register for more than 5 classes, after completing this registration form, and filling in your first 5 classes, log in to your customer portal where you will be able to register for an unlimited number of classes. If you have a coupon, please provide this information in the comment box below. You must provide credit card information in order to register online.

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

T-Shirt Size

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (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)

Additional Info

T-Shirt Size

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (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)

Additional Info

T-Shirt Size

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (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)

Additional Info

T-Shirt Size

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Payment Information

Tuition is due on the first day of each month. If tuition is paid after the tenth of the month, a $20.00 late fee will be applied to the outstanding account balance. A $30.00 returned check fee will be charged for any checks returned by the check writer's bank. No refunds, including but not limited to, tuition fees, registration fees, private/solo lesson cards, logowear/specialty show specific orders, costume fees and/or ticket fees.

I've read the above and agree.

Credit Card Charges

Monthly tuition charged to credit cards will be charged on the first day of each month. If you do not want tuition to be charged to your credit card, you may pay by cash or check in the studio office prior to the first day of the month. You understand and agree that should you not pay tuition prior to the first day of a month, your credit card will be charged the full tuition amount for that month.

I've read the above and agree.

Photography/Videography Release

By signing the registration form, a dancer engaging in activities through Artistry Dance Project, LLC gives it permission to use any photographic and/or video images of such dancer for archival, documentation, or publicity purposes including, but not limited to, Artistry Dance Project, LLC affiliated websites, Facebook pages, and advertisements.

I've read the above and agree.

Class Cancellation

Some classes held at Artistry Dance Project, LLC require a certain number of students. In the even a particular class sponsored by Artistry Dance Project, LLC cannot be held do to the minimum number not being attained, a credit will be applied toward a like class, or if no like class is available, a refund of the full class tuition will be paid.

I've read the above and agree.

Release and Waiver

I do hereby release, waive and discharge Artistry Dance Project, LLC ("Studio") and its affiliates, trustees, directors, officers, employees and agents ("Releasees") from any and all present and future liabilities, obligations, damages, losses, claims, demands, costs or expenses ("Claims") that may be made by me, my family, estate, heirs, or assigns for property damage, personal injury, loss, obligation, expense or penalty, including attorneys' fees, for personal injury, or wrongful death arising as a result of my participation in Studio classes, events or instructional workshops ("Studio Activities"), whether caused by the negligence or carelessness of Releasees or otherwise including, without limitation, in connection with transportation to and from the Studio. I understand that participation in Studio Activities involves certain risks, including, but not limited to, serious injury and death. I am voluntarily participating in the Studio Activities with knowledge of the danger involved and agree to accept all risks of participation.

I understand that Releasees do not have medical personnel available at the Studio but I consent to administration of first aid and other medical treatment in the event of injury or illness. I also agree to indemnify and hold harmless the Releasees for all Claims arising out my participation in Studio Activities and all related activities and any medical treatment.

By signing below, I or my son or daughter knowingly and voluntarily assume(s) all such risks, and assume(s) sole responsibility for any accident or injury to me or him/herself and other persons or property arising out of or in connection with participation in Studio Activities.

Ages 18 and Over
I am of legal age and am freely signing this Release and Waiver. I have read this Release and Waiver and understand that by signing this Release and Waiver, I am giving up legal rights and remedies. In signing, I represent that I have read the contents of this Release and Waiver, that I understand it, and that I sign it voluntarily.

Parent/Legal Guardian
If participant is Under Age 18, I am the parent of legal guardian of the Studio Activity participant. I am of legal age and am freely signing this Release and Waiver on behalf of the Studio Activity participant. I have read this Release and Waiver and understand that by signing this Release and Waiver, I am giving up legal rights and remedies on behalf of myself, the Studio Activity participant and his/her family, estate, heirs, and/or assigns.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

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*