Dance Concept, LLC Online Registration

Registration

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Online Registration for Adult Hip Hop is available. Online registration for all other classes is currently closed. If you have questions, please contact our office. 817.738.8763 or dance@dance-concept.com

* 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

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

Please click on the button below, then choose the class(es).

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

Please click on the button below, then choose the class(es).

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

Please click on the button below, then choose the class(es).

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

Please click on the button below, then choose the class(es).

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

Please click on the button below, then choose the class(es).

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Release of Liability

I acknowledge that, due to the physical activity associated with dance classes, there is no Assumption of risk taken on by Dance Concept, and I release Dance Concept from all liability associated with any class(es).

I've read the above and agree.

Withdrawal Policy

I agree to notify the Dance Concept office immediately if my child withdraws from class(es), and understand that I am responsible for all charges due before date of withdrawal.

I've read the above and agree.

Payment Policy

For all classes except Adult Hip Hop, please choose Monthly or Semester tuition.
A credit card is required to be on file and payments will be automatically run on their due date. Monthly tuition is due on the 1st of each month (Sept through May), Semester tuition is due 9/30 and 1/31. Performance Bundle payments will be run in three installments, 11/15, 12/15, 1/15.
If desired, payments can be made in advance through your Parent Portal or in the office.

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*

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*