StarMakers Dance Company Online Registration

Registration

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Welcome to StarMakers Dance Company Online Registration. Please fill out the information below and 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 # * 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

Student Email

School

Grade Level

Allergies*

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

Allergies*

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

Allergies*

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

Allergies*

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

Allergies*

Add Another Student

Required Policies and Agreements

I agree to waive and release StarMakers Dance Company, LLC and its members, agents, and employees from and against any and all claims, cost liabilities, expenses, or judgments, including attorney's fees and court costs arising from my child's (or my) participation in the StarMakers Dance Company program or any illness or injury resulting therefrom.
I further agree to indemnify and hold harmless StarMakers Dance Company from and against any and all such claims. I understand and agree that StarMakers Dance Company shall not be responsible for the conduct of other users of StarMakers Dance Company or its facilities.
I understand and agree that by signing this waiver, I am freeing StarMakers Dance Company and its members, agents, or employees from any liability resulting from my child's (or my) participation in any activity, on and off premise, related to the this program.

I've read the above and agree.

I give my permission to StarMakers Dance Company to photograph me or my children participating in the programs for use in StarMakers publicity and publications and will not seek compensation for such.

I've read the above and agree.

I hereby represent that I understand and am familiar with the nature of activities in which my child will participate and have personally read and understand this Release.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments