Millennium Dance Company MN Online Registration

Registration

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Please note there is a $25/dancer, $35/family non-refundable registration fee that will be charged at the time of enrollment to the card on file. Your placement in a class is not reserved until payment for first month's tuition and registration fee has been processed. There is only a registration fee for the 2018-2019 school year program, not for summer. Recreation dancers new to MDC receive their first month's tuition free; one offer per family.

* 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)

Additional Info

Disabilites

Special Needs

Allergies

Medications

* Please note that all 2018-2019 school year classes have a costume fee. Half is due on November 1st and half due on December 1st. Costume fees are $65-75 PER COSTUME. Call or email with any questions.

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

Disabilites

Special Needs

Allergies

Medications

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

Disabilites

Special Needs

Allergies

Medications

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

Disabilites

Special Needs

Allergies

Medications

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

Disabilites

Special Needs

Allergies

Medications

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

We recognize and acknowledge that certain risks of harm are or may be inherent in the various activities contemplated herein and that Millennium Dance company and its employees, staff, teacher's assistants and faculty cannot control all of these risks. We are aware that dance training and the exercises associated with it place unusual stress on the body and carry with them the risk of physical injury. I/We assume the risks involved. I/We also understand that dance instruction involves kinetic correction that may include physically touching the student (Participant) as part of the regular class work and/or rehearsal.

I've read the above and agree.

Release of Liability

In consideration of Millennium Dance Company providing the opportunity for and permitting the undersigned (Participant) to participate and take part in the event and its related activities, the undersigned Participant and Parent, if applicable, of the Participant, do hereby release, remise and forever discharge, indemnify and agree to HOLD HARMLESS WAIVE, DISCHARGE, and COVENANT NOT TO SUE Millennium Dance Company, their officers, employees, faculty, instructors, servants, agents and assigns, hereinafter referred to as RELEASEES, from any claim, demand or cause of action whether now in existence, or hereafter arising for any loss of personal property, injury to the Participant or for the death of the Participant, arising out of resulting from, caused by or contributed to in whole or in any part by any action or failure to act, negligence, breach of contract, or other misconduct on the part of Millennium Dance Company, its officers, faculty, agents, servants, employees, (RELEASEES) any other Participant in said workshop, any participating parent and/or any one or more of any thereof.

I understand that Millennium Dance Company will not be responsible for any medical costs associated with any injury that I, my child, or spectator guests that we invite, may sustain.

I understand that Millennium Dance Company, its employees, faculty, staff and teacher's assistants may take photos of my dancer on occasion during class, while on-site at Millennium Dance Company, and while off-site at Millennium Dance Company events including but not limited to competitions, conventions, parades and recitals. I understand that these images may be used for social media and advertising purposes. I understand that I must let Millennium Dance Company know in writing if I would like for my child to NOT be included in any images used for the sake of advertising and social media through Millennium Dance Company.

I've read the above and agree.

Payment Policies

I understand my school year tuition is due on the 1st of each month and must be paid by cash or card. I understand if my account is not current by the 15th I will incur late charges.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number