Elite Dance Studio Online Registration

Registration

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* 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)

Additional Info

T-Shirt Size

Enroll in Classes

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Add Another Student

Required Policies and Agreements

Media

I understand that my daughter/son may be photographed or taped and her/his image may be used on the website, facebook page or newspaper ad for the use of advertising or promoting Elite Dance Studio.

I've read the above and agree.

Assumption of Risk

I am fully aware of and anticipate the risks associated with my child's participation in class or competitions.

I understand that my daughter/son may participate in extracurricular events at studio such as bouncers, relay games, parties for fun. I won't hold Elite Dance Studio liable for any injuries that may occur during that time.

I've read the above and agree.

Release of Liability

Elite Dance Studio will not be responsible for any clothing or other items left behind or placed in a cubby.

I further agree that Elite Dance Studio and all its employees shall not be liable for any losses, damages or injuries that may result from participation in class or competition.

I've read the above and agree.

Payment Policies

Registration fee is required for all students once a year. This fee is non-refundable.
Payments are due on the First lesson of each Month.
There will be no reduction or credit of class fees for missed classes.

I've read the above and agree.

I understand this agreement is a contract and shall remain in effect for the duration of my child(ren)'s participation in Elite Dance Studio, Inc. activities. This agreement contains the entire agreement between the parties and supersedes any prior agreement whether oral or written. This Release Agreement shall bind my heirs, personal representatives, assignees and all members of my family, including minors.

I have read and agree to the assumption of risk, waiver and release of liability agreement & permission to treat in an emergency policy.
I have read and agree to abide by the rules and policies.

I've read the above and agree.

Emergency

I have fully and accurately completed the Medical Information section on my child(ren)'s registration form and assert that my child(ren) has/have no physical condition that would prevent or hinder his/her/their participation.

In the event of any injury, I authorize Elite Dance Studio, Inc. and its employees to administer first aid, transport my child to a hospital, initiate medical treatment and hold my child until I can be notified.

I've read the above and agree.

I understand it is my responsibility to inform the front desk AND coach/teacher of any changes in my daughter's/son's physical, medical or mental ability to participate at activities at Elite Dance Studio. Including; but limited to, routine immunizations, pupil dilation, falls/injuries at school or home, medication changes.

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

I agree to the following:*

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