The Anna Marie Dance Studio Online Registration

Registration

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If you are a new family/student please contact the office at (302) 475-3949 or email us at AMDS.DE@gmail.com to discuss proper class placement. Please note that Anna Marie Dance Studio must approve each students class placement. If a student is enrolled in an inappropriate level AMDS will reach out to discuss alternative classes.

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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

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

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

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)

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

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

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)

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

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

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)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Class Placement

Anna Marie Dance Studio must approve each students class placement. It is our policy to offer appropriate opportunities to every student. Placement decisions are derived from many years of teaching experience. Often a student is placed in a particular group or class where he or she will feel confident, in order to promote the development of self-esteem. Some students who are placed in a higher level become discouraged, only to lose their passion for dance. Others respond to the challenge of being in a class with students who are more proficient by pushing themselves to work harder. Placement is highly individual and the factors that go into the decision are complex. Parents/Students should only enroll in classes that were previously recommended via your 2019 schedule recommendation form. If a student is enrolled in an inappropriate level AMDS will reach out to discuss alternative classes.

I've read the above and agree.

Release of Liability

As the legal parent or guardian, I release and hold harmless The Anna Marie Dance Studio, 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 The Anna Marie Dance Studio, 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 The Anna Marie Dance Studio, 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, restrictions, or condition and/or declare the participant to be in good physical and mental health.

I've read the above and agree.

Photo/Video Consent

Students of the Anna Marie Dance Studio may have the opportunity to be photographed or video taped at various events. These photos or video may be included in the Anna Marie Dance Studio publications or advertisements, including but not limited to our website. To ensure privacy, specific names of children will not be included. No financial compensation shall be given for use of any photographs or video. The Anna Marie Dance Studio reserves the right to discontinue use of photos or video without notice.

I've read the above and agree.

Payment Information

Tuition at Anna Marie Dance Studio is based on a ten-month class schedule, running September through June, and payable monthly. Tuition rate is based on total hours per family. The September and June payments are due at the time of your first class in September. Tuition payments from October through May are due at the time of the first class of each month.

A non-refundable registration fee of $25 per student is payable upon registration.

A $15 late fee will be charged if tuition is not received by the 15th of the month. If your account balance is not paid in full the Anna Marie Dance Studio reserves the right to withhold recital costumes or restrict the student's eligibility to attend classes until tuition is up-to-date.

A $25 fee will be charged for any check returned by the bank. If collection is necessary, parents/guardians are responsible for collection fees, court costs, etc.

Please note: There will be no prorate, reduction or refund on tuition for any reason. Your position in class is reserved for the student, whether they attend or not. Therefore, consistent and equal tuition payments must be made each month regardless of your attendance. Make up classes are offered to those students who are not able to attend their regularly scheduled class.

Parents/guardians who wish to withdraw a student from our school MUST DO SO IN WRITING. You are financially responsible for tuition payments up to the time that the letter/email is received by our office.

All payments to Anna Marie Dance Studio are non-refundable.

I understand that any Credit Card payments are subject to a 3% surcharge. If you choose to have your payment auto debited each month the amount charged will be total balance unless notification is provided to the Anna Marie Dance Studio prior to processing. If auto debit option is not chosen The Anna Marie Dance Studio reserves the right to process payment on accounts greater than 45 days past due. The charge will appear on your credit card statement.

I understand that this authorization will remain in effect until I cancel it in writing at least 15 days prior to the next billing date. If the payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of the Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms above. I authorize Anna Marie Dance Studio to charge my Credit Card.

I've read the above and agree.

I Agree to All of the Above

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Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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*