Nine Ladies Dancing Online Registration

Registration

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Welcome to Nine Ladies Dancing-Dance Academy! We are so glad you found us!

* 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

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

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

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Skill Notes

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

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Skill Notes

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

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Skill Notes

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

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Skill Notes

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

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Skill Notes

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Concussion Waiver

Concussion waiver: As a parent and as a participant it is important to recognize the signs, symptoms, and behaviors of concussions. By signing this form you are stating that you have read the concussion awareness information and understand the importance of recognizing and responding to the signs, symptoms, and behaviors of a concussion or head injury. I am aware of the signs and symptoms of concussions.

https://docs.wixstatic.com/ugd/c807bb_b4daada35fab45608882c8c6c0d8f46e.pdf

I've read the above and agree.

Promotional Waiver

I agree to allow any images or videos of my child to be used for promotional purposes of Nine Ladies Dancing.

I've read the above and agree.

Policy Page

Please review and agree to all of the policies listed on the link below.

https://docs.wixstatic.com/ugd/c807bb_302df1552fc94418a56af075345e1c88.pdf

I've read the above and agree.

Important Informantion and Policies

Studio Closing: If you are unsure if the studio will be closed due to poor weather conditions, follow our Facebook page and check your email.

Low Enrollment: If your child is registered for a class that has low enrollment, we reserve the right to offer your child a similar class in place. No refunds but credit can be applied to a different class.

Food and Drink: No gum, food, or drinks inside the studio space. Only water is allowed. We welcome our families to eat in the commons area. We just ask for everyone to clean up wrappers, drinks and crumbs off the tables.

Observation: Parents are welcome to watch their students from inside the studio only during scheduled observation weeks. (See the calendar below for schedule observation weeks).

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

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