WEBBY Dance Company - Dayton Online Registration

Registration

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WEBBY Dance Company will be offering fun & exciting Dance and/or Gymnastics classes for the 2019-2020 school year held weekly at your child's school! First month's tuition & the annual registration fee, which includes a WEBBY t-shirt, is due upon enrollment. - Your card is NOT automatically charged upon registration, our office will process your card after receiving your enrollment! - Please email HMatteson@webbydancecompany.com with any questions!

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Student's Last Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Automatic Monthly Pmts? (Y/N)*

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

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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

T-Shirt Type (Boy or Girl)*

T-shirt Size (XS, S, M, L)*

Classroom (at School)*

Please select the class(es) in which you would like to enroll your child. - DANCE: Your child will be introduced to beginning tap, ballet, rhythm, & movement skills. Tuition for Dance class is $48.00 per month. - GYMNASTICS: Your child will be introduced to beginning tumbling, stretching & gross motor skills. Tuition for Gymnastics class is $48.00 per month. -- We do offer discounts for BOTH Dance & Gymnastics (90.00 per month) and families!

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

T-Shirt Size

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

T-Shirt Type (Boy or Girl)*

T-shirt Size (XS, S, M, L)*

Classroom (at School)*

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

T-Shirt Size

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

T-Shirt Type (Boy or Girl)*

T-shirt Size (XS, S, M, L)*

Classroom (at School)*

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

T-Shirt Size

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

T-Shirt Type (Boy or Girl)*

T-shirt Size (XS, S, M, L)*

Classroom (at School)*

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

T-Shirt Size

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

T-Shirt Type (Boy or Girl)*

T-shirt Size (XS, S, M, L)*

Classroom (at School)*

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Liability Release

Your child will remain under the care, direction and supervision of the school while receiving instruction from WEBBY Dance Company. I hereby release and discharge WEBBY Dance Company and it's members from all actions, claims or demands, I, my heirs, distributees, guardians, legal representatives, or assigns now have or may have in the future for injury or damage resulting from my child's participation in this activity.

I've read the above and agree.

Photo Release

I grant permission for my child to be photographed and to appear in any components of media communication. I understand the photographs may be used as promotional material for WEBBY Dance Company.

***IF YOU DO NOT GRANT PERMISSION FOR YOUR CHILD TO BE PHOTOGRAPHED: Please check the box AND add "NO PHOTOS" to the comments section below!***

I've read the above and agree.

NEW! Text Messaging Updates

We will be sending important, time-sensitive notifications regarding your child's WEBBY classes via text message! - We will use text message notifications to alert parents & families of things like canceled classes, make-up classes and important deadlines!

You will be automatically enrolled in our text message alerts/notifications system by providing a valid cell phone number above UNLESS you choose to opt-out of our text messaging feature...

*To OPT-OUT*** of our text message notifications, please email: HMatteson@webbydancecompany.com
***By opting out of text message alerts, I UNDERSTAND that I may NOT receive time-sensitive information pertaining to my child's WEBBY classes!

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*