Artistic Dance Academy, LLC Online Registration

Registration

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Welcome to Artistic Dance Academy's on-line registration. Please complete the registration form and hit submit.

* 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
(Not Contact #1 or #2)

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)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Class Selection

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Class Selection

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Class Selection

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Class Selection

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Class Selection

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Participation Release

I hereby give permission for my child or myself to fully participate in the Artistic Dance Academy programs. I understand that, as with any sport, there are certain inherent risks in dance and gymnastics participation, and that I, intending to be legally bound waive and release Artistic Dance Academy and its employees of all responsibility for any injury sustained by my child or myself in connection with Artistic Dance Academy, its owner, employees or its facility. I also understand that it is the studio policy that all children are not permitted to play outside on the property grounds. I understand and agree that any children I bring to the studio will remain inside and studio facility and that they will remain in my care and that it is my sole responsibility to watch out for their wellbeing both inside Artistic Dance Academy and on the grounds.
Tuition is due on the first class of the first week of the month. A $10.00 late fee will be added to all tuition received after the 10th day grace period and $15.00 late fee will be charged after the 15th day.
There is a $30.00 fee for all returned checks. Once a student is enrolled into a group or private class, payment for the entire month is due regardless of any or all missed classes by the student. There are no makeup classes. If a student is no longer participating in our program a notification must be made before the next month begins or you will be held accountable for that next month's tuition, no matter what.
Proper attire, hair and shoes must be worn at all times. Being on time is a vital part of respect for both the teacher and other students. If you are more that 15 minutes late it is up to the teacher's discretion if the student may part take in class. Please be on time!
There are absolutely no refunds for classes, registration fees, recital tickets or recital costumes, Once the costumes have been ordered, the parent is responsible for this payment to the studio.
Costumes sizes are ordered by measuring the student and ordering those sizes according to size charts set forth by the costume company. Most recital costumes fit very well. However, due to different sizes and shapes of some children, most notably long girth measurements, some costumes may need to be altered and will be taken care of by the parent.
If you chose to have an automatic payment done, the money will be charged on the 10th of the month.

I've read the above and agree.

Media Release

Artistic Dance Academy highlights positive events, and programs in publications such as the studio web-site, advertising and press releases.
ADA's Media/Photo release form allows you to withhold consent for the release of your child's photo or likeness in a publications or productions such as those listed. This includes.:
- Internet (Web Sites, Facebook, You-tube, etc.)
- Press releases
- Flyers
The Media Release form DOES NOT govern publication of a student's name.
The Media is protected by California Civil Code Section 3344 (subsection d), which states that "use of a photograph or likeness in connection with any news, public affairs or sports broadcast shall not constitute a use for which consent is required".

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*