Interplay Dance Online Registration

Registration

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Welcome to PSB & Interplay Dance Academy and thank you for joining our school.

* 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/Prov*

Postal Code*

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)

Thank you for joining our school. Please see our web site for your child's dress code.

Enroll in Classes

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Thank you for joining our school. Please see our web site for your child's dress code.

Enroll in Classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Thank you for joining our school. Please see our web site for your child's dress code.

Enroll in Classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Thank you for joining our school. Please see our web site for your child's dress code.

Enroll in Classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Thank you for joining our school. Please see our web site for your child's dress code.

Enroll in Classes

Add Another Student

Required Policies and Agreements

Emergency Permission

Emergency Permissions
You have my / our permission, in the event of an emergency and in case we are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my child as they may deem advisable.
I've read the above and agree.

I've read the above and agree.

Cancellation Policy

Cancellation Policy
No cancellations will be accepted after the first month of classes. A formal request in writing must be made in the first month in order to cancel attending the remaining classes.
I've read the above and agree.

I've read the above and agree.

Payment Agreement

For returning students, I hereby authorize PSB & Interplay Dance Academy to process my payments for the 2018-2019 season as per my 2017-2018 Pre-Authorized Debit and Credit Card Agreement unless a new form is provided.
For new students, I hereby confirm I will provide my payment details within 24 hours upon class registration. PSB & Interplay Dance Academy cannot confirm their placement in the class until the Pre-Authorized Debit and Credit Card Agreement form is provided to our office and receipt confirmed.
PSB & Interplay Dance does not accept payments online to ensure the security of your private information as well as to keep the fees as low as possible.
Pre-Authorized Payments Form: https://jackrabbitstorage.blob.core.windows.net/prod/org_526558/orgfile/PAD%20Form%202018-2019_20180621165314.xlsx
Rules & Regulations: https://jackrabbitstorage.blob.core.windows.net/prod/org_526558/orgfile/PSB%20Rules%20and%20Regulations%202018-2019_20180617225030.pdf

I've read the above and agree.

Indemnification

In consideration of PSB & Interplay Dance accepting this application, I, for myself, my heirs, executors, administrators and assigns, release PSB & Interplay, its respective servants, agents and employees from any claims, demands, damages, actions or causes of actions whatsoever arising out of or in consequence of the above-noted Student participating in a dancing lesson/course or any other activity related to PSB & Interplay, including but not limited to claims, demands, actions or causes of actions related to loss of or damage which may have arisen by reason of negligence of PSB & Interplay, its servants, agents or employees. Without limiting the generality of the foregoing, I further release any
recourses which I may now or hereafter have resulting from any decisions or activities of PSB & Interplay. For the aforesaid consideration I agree to indemnify PSB & Interplay, its servants, agents or employees from any claims or demands which might be made against the Interplay, arising out of or in consequence of the attendance or participation by the Student in a dance lesson/course or any other activity of PSB & Interplay. If this Release and Waiver is signed by any person other than the Student, the Student is under the age of eighteen (18) years, and I have full legal right and authority to sign this waiver on behalf of the Student.

I've read the above and agree.

Photo Waiver

I give permission for PSB & Interplay to use photographs of my child/children for promotional purposes
only.

I've read the above and agree.

Rules & Regulations

I have viewed and am acknowledging the Rules and Regulations, Dress Code Policy and Fee schedule. I have read all thoroughly. I will also go through these guidelines with my child so they are aware of all rules and regulations prior to class participation.

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*