Siler City Dance Academy Online Registration

Registration

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Thank you for choosing Carolina Dance and Gymnastics for your dance and gymnastics home.

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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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level*

Disabilites

Allergies

Medications

Primary Doctor

If the class you are looking for is full, please register (either for waitlist or leave class selection blank) and put class name and preferred class time in the comment box.

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

Allergies

Medications

Primary Doctor

If the class you are looking for is full, please register (either for waitlist or leave class selection blank) and put class name and preferred class time in the comment box.

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

Allergies

Medications

Primary Doctor

If the class you are looking for is full, please register (either for waitlist or leave class selection blank) and put class name and preferred class time in the comment box.

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

Allergies

Medications

Primary Doctor

If the class you are looking for is full, please register (either for waitlist or leave class selection blank) and put class name and preferred class time in the comment box.

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

Allergies

Medications

Primary Doctor

If the class you are looking for is full, please register (either for waitlist or leave class selection blank) and put class name and preferred class time in the comment box.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Payment Options

*Monthly Automatic Payment by Credit/Debit Card
*One Time Payment (Special Events only)

I've read the above and agree.

All Inclusive 10 month Program

No Registration Fees-No Costume Fees-No Recital Fees

10 Easy Automated Monthly Payments (1st month's payment processed upon registration, remaining payments are processed the 1st of each month-September through June)

Classes Meet for 10 months (September 1st-June 30th)

Students are encouraged to make up any missed classes at a class their level or lower at either location.

I've read the above and agree.

Payment Information

I understand that I am enrolling my child for the ENTIRE school year for classes that meet September-June (not summer camp) and am responsible for ALL payments for the school year, whether the student is present for class or not. We are a private school and base our classes on enrollment. If a student drops mid-year that is a spot that another student could have had, but we are unable to fill mid-year. We encourage students to finish what they start. Drops are available with a full month's notice given though our online drop form for circumstances such as moving and illness.

Tuition is based on the full year's tuition and divided into 10 easy monthly payments. All Payments are non-refundable.

After the 6th, I understand that I will be accessed a $20 late payment fee. I also understand that I will be charged a $25 NSF fee on all returned payments.

I've read the above and agree.

Release of Liability

As the legal parent or guardian, I agree to hold Carolina Dance and Gymnastics, its owners, teachers, and staff, and Masonic Lodge #403 (Siler City Location), its officers and members, free from any and all liability arising out of my child's participation in this class including, but not limited to: muscle strains, tears, pulls, broken bones, death, and any and all illness, or loss of personal property. I authorize the staff to seek medical treatment at the nearest hospital if necessary.

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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Credit Card

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Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*