Lecky School of Dance Online Registration

Registration

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Welcome to the Lecky School of Dance Registration Page. This is for families and students that are new to Lecky Dance. If you or your children have danced with Lecky School of Dance, then please use your parent portal or click on the above link to login.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name Last Name*

Where do you live?

Home Address*

City*

Province*

Postal Code*

Home or Primary Phone*

Additional Info

Emergency Contact Info
(Not Contact #1 or #2)*

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Cell # *

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

Type

How can we contact you?

Cell # *

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities

Special Needs

Allergies

Medications

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities

Special Needs

Allergies

Medications

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities

Special Needs

Allergies

Medications

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities

Special Needs

Allergies

Medications

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School

Disabilities

Special Needs

Allergies

Medications

Add Another Student

Required Policies and Agreements

Release of Liability

As the parent or legal guardian of the enrolled student(s), I hereby agree to abide by the terms specified here which I have read and fully understand. I hereby give my approval for participation in the physical activities associated with Lecky School of Dance. I release and hold harmless Lecky School of Dance, its owners, administrators, staff, instructors and volunteers from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises under the control and supervision of Lecky School of Dance or in route to or from said premises.

I've read the above and agree.

Medical Emergency

In the event of an injury, I give permission to Lecky School of Dance, its owners, administrators, staff, instructors and volunteers to seek medical treatment for the participant if they are not able to reach a parent or guardian.

I've read the above and agree.

Payment Policies

By signing this agreement, I (as the parent/guardian or adult registrant) agree to the following Lecky School of Dance payment policies.
I understand tuition fees are based on a set number of classes and programming expenses from September to June and do not correspond to the number of weeks in any one month.
I understand enrollment in a "School Year" class commits the student to the full school year. If for any reason I must withdraw my student from a class I must give written notice 30 days prior to withdrawal. I realize there are no refunds for missed classes however; students have the option of taking an extra class to make up for the lesson missed if another class at the same level is offered.
I also understand that refunds are not given once a "Term Session" class starts, and that "Registration Fees", "Competition Fees", "Exam Fees" and "Costume Fees" are non-refundable.
Lecky School of Dance reserves the right to cancel classes (due to unforeseen circumstances such as instructor illness, inclement weather, building issues). In such cases, every effort will be made to reschedule classes cancelled by the studio.

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

Province

Postal Code

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Transit # (5-digits)

Institution ID (3-digits)

Account Number