TNT Dance Explosion Online Registration

Registration

Already a customer? Click here to login.

TNT Dance Explosion Online Web Registration

* 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)

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

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

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

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

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

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Fees

Full payment is due upon registration. Your credit card on file will be charged within 10 days.
This will include the first installment and a $35 registration fee.

Registration fee is Waived for Summer Programs.

I've read the above and agree.

Risk and Waiver of Liability

Acknowledgement of Risk and Waiver of Liability
The undersigned, who is the parent or legal guardian of the above referenced student, hereby acknowledges the risk of injury, illness or other physical harm in the activities in which the student will be participating as part of the program provided by TNT Dance Explosion, and the undersigned, to the extent possible pursuant to the law of the State of New York, on behalf of the student and the student's natural or adoptive parents, hereby agrees to waive and release all claims and/or causes of action against TNT Dance Explosion arising out of personal injury, illness, disability or damage of any kind in connection with or alleged to be in connection with activities, participation, and presence of the student in the said activities, whether on or off the business premises of TNT Dance Explosion.

This acknowledgement of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent.

I've read the above and agree.

Photo Release

TNT Dance Explosion has my permission to use any dance studio picture of my child, taken either during class time, performance or at the end of the dance season by a hired photographer for purposes of illustration, advertising, promotion, display or publication, and for any other lawful purpose including social media.

I've read the above and agree.

Credit Card on File

All families need to have a credit card on file and agree to have that card charged if payment is not made by the 8th of each month.
You may select and auto-payment of the 1st, 5th or 10th without penalty, or you may pay with cash, check or credit card of your choice prior to the 8th.

You agree to the terms set forth in the above agreement, and authorize TNT Dance Explosion to charge your credit card on file if monthly installments and other fees due are not paid by the 8th of each month.

TNT Dance Explosion reserves the right to suspend service for unpaid fees, credit card rejections, or other non payment.

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*