Star Performance Dance Centre Online Registration

Registration

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Star Performance Dance Centre

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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

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 #

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

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Please follow all guidelines listed in the class description when enrolling your child in classes. *SPDC has the right move a child out of a class that she/he does not belong in. *SPDC has the right to cancel a class if there isn't enough students. *SPDC's has the right to change class times/days. *$25 new student $15 Returning student registration fee applies for fall season

Enroll in Classes

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

Please follow all guidelines listed in the class description when enrolling your child in classes. *SPDC has the right move a child out of a class that she/he does not belong in. *SPDC has the right to cancel a class if there isn't enough students. *SPDC's has the right to change class times/days. *$25 new student $15 Returning student registration fee applies for fall season

Enroll in Classes

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

Please follow all guidelines listed in the class description when enrolling your child in classes. *SPDC has the right move a child out of a class that she/he does not belong in. *SPDC has the right to cancel a class if there isn't enough students. *SPDC's has the right to change class times/days. *$25 new student $15 Returning student registration fee applies for fall season

Enroll in Classes

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

Please follow all guidelines listed in the class description when enrolling your child in classes. *SPDC has the right move a child out of a class that she/he does not belong in. *SPDC has the right to cancel a class if there isn't enough students. *SPDC's has the right to change class times/days. *$25 new student $15 Returning student registration fee applies for fall season

Enroll in Classes

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

Please follow all guidelines listed in the class description when enrolling your child in classes. *SPDC has the right move a child out of a class that she/he does not belong in. *SPDC has the right to cancel a class if there isn't enough students. *SPDC's has the right to change class times/days. *$25 new student $15 Returning student registration fee applies for fall season

Enroll in Classes

Add Another Student

Required Policies and Agreements

SPDC has the right to cancel or change any class or class schedule prior to the ordering of costumes. If a class ability is not correct, enrollment is low or any other circumstance presents a class could get cancelled or changed.

I've read the above and agree.

Release of Liability

As the legal parent or guardian, I release and hold harmless SPDC, 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 SPDC, its owners and operators or in route to or from any of said premises. SPDC is not responsible for injuries on premise, at recital, competitions or any other event SPDC attends or holds.

I've read the above and agree.

Personal Items

SPDC is not responsible for lost or stolen items on premise, at recital, competitions/conventions or any other event SPDC attends or holds.

I've read the above and agree.

Medical Emergency

The undersigned gives permission to SPDC, 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.

Costume

SPDC is not able to refund costume money after they are ordered.

I've read the above and agree.

Photography/ Video Release

SPDC may take photos and videos of your child for promotional use.

I've read the above and agree.

Registration Fee

$25 new student and $15 returning students. Payment due when you your register your child for classes. If you register online your registration fee is due with in 7 days of registering. Fee free to stop into the studio to pay or you may mail a check to PO Box 334 Vernon NY 13476
*You must pay your registration fee within 7 days of enrolling online to hold your spot in the class & your first tuition installment (if you plan to pay in monthly installments) is due by August 1st, if you are paying yearly or semesterly a $100 deposit is required.
***Registration Fee's are only for the Fall Registration for the Full Year season!

I've read the above and agree.

Payment Information

Payments may be done:
*Biweekly- Only available for tuition of $100 or more per month (Due 1st&15th) (20 installments)
*Monthly Installments- Due by the 5th of each month (10 installments) (any payment past the 5th of the month will have a $10 per week late fee. Your First installment is due in August with your registration fee. Any payments more than 30 days behind will be subject to suspension from classes)
*3 Installments- Due 9/21, 12/10 & 3/10 (Save 1 monthly installment)
*Yearly- Due 9/21 (Save 1 ½ month installment) Tuition is pro-rated and based on a 10 month dance year ( payments Aug-June. It remains the same each month whether it is a long 5 week month or short 2-3 week month & regardless of absences ( recital rehearsals are included as well). For more savings pay 3 installments or yearly. Any student who reaches the 5 hour a week tuition is capped at that amount, students may take any extra classes, or open classes at their level or below free of charge. Please ask about out family discount. 5% applied to any credit card charge, $30 returned check fee, $10 late fee, Suspension of lessons if more than 45 days late. No refunds except for long term injury with Dr note or if you move out of the area more than 50 miles.

I've read the above and agree.

Competition Team parents

If your part of the competition team the following applies: If Tuition, Costume payments & entry fees aren't current my child cannot attend optional competitions or conventions. Once a dance is entered into a competition there is no refund. Competition "winnings" will not be credited until after the competition releases them. "Winnings" will be credited towards your tuition, if tuition is paid in full the remainder will go into your competition account. Students must participate in all required classes in order to be eligible for competitions.

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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