To The Pointe Dance Online Registration

Registration

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Thank you for registering! By registering, you are authorizing To The Pointe to charge your card on file the following: a $20.00 registration fee per dancer for 2019-2020 Recital Based Dance Classes; a $40.00 registration fee ($20.00 each additional child) for After School Kids Care; full tuition for Non-Recital Based Dance Classes (drafted the first day of class); a $50.00 deposit for each week of camp. *PLEASE NOTE: THESE FEES ARE NON-REFUNDABLE*

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Dancer's Last Name Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Coupon Code

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)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo Release (Y/N)?*

A dancer's age is determined by 8/31/2019 for all 2019-2020 Classes, including Summer 2019 Classes and Camps. A dancer's age is determined by 8/31/2020 for all 2020-2021 Classes, including Summer 2020 Classes and Camps

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

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)

Photo Release (Y/N)?*

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)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo Release (Y/N)?*

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)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo Release (Y/N)?*

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)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo Release (Y/N)?*

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 To The Pointe Dance & Arts Academy, LLC, 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 To The Pointe Dance & Arts Academy, LLC, its owners and operators or in route to or from any of said premises.

I've read the above and agree.

Medical Emergency

The undersigned gives permission to To The Pointe Dance & Arts Academy, LLC, 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 agree to provide any physical/mental problems, restrictions, or condition in the comments section below. By not placing any comments in the comments section, I declare the participant to be in good physical and mental health.

I've read the above and agree.

Payment Information

Tuition is due by the first of each month. If accounts are paid after the fifth of the month, there will be a $15.00 late fee applied to the account balance. For any fees that go unpaid longer than 60 days, a 10% monthly finance charge will be added. For the due dates of other fees, please see the Studio Calendar. There is a $25.00 returned check charge for any checks returned by the bank. Any fees paid are non-refundable. In the case that legal action must be taken to obtain payment of an outstanding balance, you will be responsible for any and all legal fees incurred.

I've read the above and agree.

Photo Release

By selecting Yes under the Photo Release section, I grant permission to To The Pointe Dance & Arts Academy, LLC to use photographs and/or video of my child in publications, news releases, online, and in other communications related to the mission of To The Pointe Dance & Arts Academy, LLC.

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*