Expressions DanceCompany Online Registration

Registration

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Welcome to Expressions Dance Company! We are looking forward to meeting you in September! Please complete the following registration form.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Account 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)*

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

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)

Cell #

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

Please click on the Search button below, then choose the class.

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

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

Please click on the Search button below, then choose the class.

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

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

Please click on the Search button below, then choose the class.

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

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

Please click on the Search button below, then choose the class.

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

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skill Notes

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Release Form

I acknowledge that there may be use of photo/digital/video images of my child/self for: recital, advertisements, or displays. These images may be posted on the Internet such as: the studio website, Facebook, Instagram or Twitter. These images will be posted in the sole discretion of Expressions Dance Company.

I've read the above and agree.

Waiver of Responsibility

In order to be permitted to participate in any way in dance classes at Expressions Dance Company. I (the parent/guardian) of the minor participant (the dancer under age 18) or the participant (the dancer over 18) named below agree to the following:
- I acknowledge that participation in dance classes may result in bodily injury and/or potential health risks including partial and/or total disability.
- I, for myself, my heirs, executors, administrators, successors, and assigns hereby release and forever discharge Expressions Dance Company, all other organizations, associations, and companies associated with any of the programs offered by Expressions Dance Company and all of the owner, promoters, respective agents, employees, servants, contractors, representatives, successors, and assigns of and from all claims, demands, damages, costs, and actions whatsoever, and however caused, arising by any reason of the participation in dance classes and any of it’s associated activities.

I've read the above and agree.

Payment Terms

In order to reserve your spot in one of our classes you must submit a non-refundable registration fee for today's date. We will not hold a spot in any class for an individual without the registration fee or the full amount.

All prices include HST.

Payment can be made by:

Monthly Payments for 10 months
- VISA or MasterCard automatic payment -office will charge card upon the 25th of the prior month, each month
- Bank Draft automatic payment - office will charge bank upon the 25th of the prior month, each month

Annual Payment
- VISA or MasterCard full amount
- Bank Draft full amount

I understand the following:
• Payments made after the first of the month will be subject to a late fee of 5% per week
• Holidays such as March break, and Christmas have already been worked into the monthly price and there is no discount for these months
• Missed classed on my behalf are my responsibility to arrange a make-up class if applicable and there is no discount to the monthly price if a class is missed on my behalf
• If I choose to withdraw from a class at anytime throughout the year notice must be given prior to the first of the following month in order to not be charged for that month.
• If paid annually and I choose to withdraw from a class at anytime throughout the year a refund will be given for the remainder of the year

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

Payment Option*

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