On Pointe Arts Online Registration

Registration

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Welcome to On Pointe Arts! Please provide your information below and click submit when complete. You will NOT be charged at this time. All enrollments are considered pending until we have reviewed your registration and posted any fees due. Applicable discounts will be applied as well. You will need to either call or stop into the studio to pay and complete your registration.

* 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*

State*

Zip Code*

Home or Primary Phone*

Additional Info

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

Health Insurance Carrier

Contact #1

Contact #1 (Primary) 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

T-Shirt Size

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

Choose any filters to begin viewing available classes. Please contact the studio if you have trouble finding or enrolling in classes.

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

T-Shirt Size

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

Choose any filters to begin viewing available classes. Please contact the studio if you have trouble finding or enrolling in classes.

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

T-Shirt Size

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

Choose any filters to begin viewing available classes. Please contact the studio if you have trouble finding or enrolling in classes.

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

T-Shirt Size

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

Choose any filters to begin viewing available classes. Please contact the studio if you have trouble finding or enrolling in classes.

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

T-Shirt Size

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

Choose any filters to begin viewing available classes. Please contact the studio if you have trouble finding or enrolling in classes.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Waiver of Liability and Indemnity Agreement

I understand that dance classes may include, without limitation, dancing with props, stretching, barre work, across the floor combinations, dance routines in the center, and other related activities. I further understand that all of the activities of the dance class involve some degree of risk of strain or bodily injury. I hereby release ON POINTE ARTS LLC, its staff contractors, volunteers and the event facility from any liability for personal injuries or loss of, or damage to personal property. I give permission to ON POINTE ARTS LLC to provide and/or seek medical attention for my child should medical treatment be required and I will assume all costs of my child/children's medicals bill(s). Each participant may refuse to participate in any activity. If there are any doubts as to a dancer's physical ability, please consult your physician before participating.

I've read the above and agree.

Reciept of Information

I have received the student handbook and agree to adhere to all the content stated therein including:
*Studio Policies *Tuition & Payment Information *Dress Code
I agree to be responsible for reading studio correspondence and respecting deadlines, if applicable.
I also understand that there are NO REFUNDS at any time for any reason.

I've read the above and agree.

Photography and Videography Release

I consent to and authorize the use and reproduction by ON POINTE ARTS LLC of any and all photographs and any other audio/visual materials taken of myself, my son/daughter without compensation for advertising purposes. I understand that the use of these photos will NOT include the use of my son/daughter's or my own name when used for online purposes, unless further authorization has been given.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number