Kinner & Co Dance Studio Online Registration

Registration

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Welcome to Kinner & Co. Dance Studio Inc. online registration! Please provide your information below and click submit when complete. Credit cards are NOT charged at this time. All enrollments are considered pending until we review your 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*

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

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)

Creative Movement for the pre school dancer Combination (Tap, Ballet, Tumbling) for the beginner 5 - 7 yr. old dancer Hip Hop: 2 levels beginner and intermediate Levels: 1 thru 6: Tap, Ballet, Tumbling, Jazz, Levels 3 thru 6: Lyrical & Contemporary

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Agerement

I agree to this. I understand that there are certain risks involved with participation in any dance activity. I expressly understand and agree that neither KINNER & CO. DANCE STUDIO INC., SPFLD., ILLINOIS OR ANY OF IT'S EMPLOYEES SHALL BE HELD RESPONSIBLE OR MADE SUBJECT TO ANY CLAIM, other than willful or reckless conduct directly attributable to them. Seeking to assess damages or liability for, or arising from personal injury or property damages to myself or other persons in whose behalf this form is now signed as a result of actual or proposed participation in the above programs.
I HEREBY AGREE TO INDEMNIFY AND HOLD KINNER & CO. DANCE STUDIO INC. OR IT'S EMPLOYEES HARMLESS ON ACCOUNT OF ANY SUCH CLAIM.

I've read the above and agree.

Permissions:

I also give permission to use Dance Photographs in which I, or a member of my family, are pictured for KINNER & CO. DANCE STUDIO INC.

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