Mary Lee's School of Dance Online Registration

Registration

Already a customer? Click here to login.

Welcome to Mary Lee's School of Dance! Please complete the following registration form. First month and registration fee must be paid at time of registration to hold place in class. You will have to go out of sight and come back in to make your payment of registration Fees and 1st month tuition.

* 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 *

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

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)

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor

Add Another Student

Required Policies and Agreements

(Show-Hide Details)

Policy and Release Form

Mary Lee's School of Dance
Policy and Release Form 2020-2021

Note any pre-existing medical conditions need to be put on file at the dance school.
As parent or guardian, or as an adult 18 years and older, I understand that dance, tumbling and cheer are vigorous physical sports that involve height, motion and speed of motion. I understand that participation in these activities can incur the possibilities of physical injury.
In consideration of Mary Lee's School of Dance allowing the above paid student to participate in its' program. I hear by release Mary Lee's School of Dance, its' owners, employees, volunteers, teachers, coaches, and spotters from all liability for any and all damages and injuries at any time suffered by me or my child arising out of dance activity.
I certify that I/my child is in good health and able to participate safely in this activity. Signing this acknowledges that it was read and understood.
I accept that I/my child will be put in an appropriate level class based on his/her ability, performance and progress as deemed by his/her instructor or director and my child's class placement may be moved based on said above.
I comply that tuition fees will be paid in full by the first of each month Oct., Nov., Dec. 2019 and Jan., Feb., Mar., April, May & 1/2 month of June 2020. Failure of said payments by the first of each month will result in a $15.00 late fee per class. I also realize that I am registering my child/me to the program and am responsible for all fees.
I agree to bring myself/my child to class on time in designated attire in accordance with Mary Lee's School of Dance. Fifteen minutes late may result in my child sitting out do to improper warm-up.
I agree to allow myself/my child to be photographed or videotaped at annual parent observation week and/or annual recital and release the tapes to be sold to parents and/or students of Mary Lee's School of Dance. I release permission to use my/their pictures in advertising for Mary Lee's School of Dance and/or Mary Lee's School of Dance website.

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

Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Student #1

Additional Info

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies and Agreements

(Show-Hide Details)