Upstage Dance Co Online Registration

Registration

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Welcome to Upstage Dance Co! Please complete the following registration form.

* 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*

Province*

Postal Code*

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 # *

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 #

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

T-Shirt Size

School*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Search button below, then choose the class. Once we receive your class selections appropriate discounts will be applied.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Search button below, then choose the class. Once we receive your class selections appropriate discounts will be applied.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Search button below, then choose the class. Once we receive your class selections appropriate discounts will be applied.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Search button below, then choose the class. Once we receive your class selections appropriate discounts will be applied.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Search button below, then choose the class. Once we receive your class selections appropriate discounts will be applied.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Participant Waiver

I hereby acknowledge that (dancers name) participates in programming at UPSTAGE DANCE CO. with the understanding that despite precautions being taken, accidents and injuries may occur.

I agree to release UPSTAGE DANCE CO, its teachers and owners of the facilities used for classes from any action, claim or demand both now and in the future, should an accident or injury occur.

I hereby give UPSTAGE DANCE CO. permission to use photographs and video taken at the location of the studios or at an event in which UPSTAGE DANCE CO. students are performing in or at, including the year-end show, community events, festivals and competitions.

Photographs may only be used in the promotion of UPSTAGE DANCE CO. and its programs with my permission and may not be used by any other business, organization or individual.

Video footage may be recorded for use as an instructional tool for review by both students and teachers during class time. The year-end show will be professionally recorded and available to purchase.

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*