IGNITE Dance and Yoga Online Registration

Registration

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Welcome to IGNITE Dance and Yoga! 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*

State*

Zip*

Home or Primary Phone*

Additional Info

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

Contact #1

Contact #1 First Name*

Last Name *

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk/ Liablity

I, The Parent or the adult student, Acknowledges that the student is taking class at their own risk and will not hold IGNITE Dance and Yoga liable in the event of physical injury or personal loss. In the event of medical emergency, all attempts will be make to first contact. If unsuccessful, this authorizes us to contact 911.
I Acknowledge that IGNITE Dance and Yoga may take photo's/videos of the students for the purpose of promoting the studio.

I've read the above and agree.

Payment Policy

Youth class tuition is calculated per student with a 10% family discount. Monthly tuition is charged to your credit card on file on the first of each month. Monthly tuition is the same amount each month regardless of how many weeks in the month (some months have more weeks, some have less, but each class meets for the same amount of classes over the school year). If you miss a scheduled class, you can use a make up day (contact us in advance for available day's) For those choosing to pay annually, there is a 7% discount (annual option is available until 9/30/19). If you would like to pay annually, please contact the front desk at 425-292-9880 or info@ignitedanceandyoga.com. If your credit card declines, you will have 7 days to rectify the situation without incurring a $25 late Fee. It is your responsibility to keep your account current. Tuition is automatically charged to your account through the end of the season. If you need to drop a class, you must submit in writing or email by the 15th of the current month to be effective the following month. There are no refunds for the current month. Refunds for annual tuition will be done on a prorated basis by calculating used portion on a monthly basis with a 7% surcharge fee for every month used.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

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*