DancExplosion Arts Center, LLC Online Registration

Registration

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Welcome to DancExplosion Arts Center! We are so excited that you have chosen us for your child's dance education. We have made enrolling your child into dance classes both, easy and convenient. With a wide array of classes and family oriented atmosphere, DancExplosion is a good fit for the on-the-go family, recreational and competitive dancer. Please complete the following registration form. We are so happy to share this journey with you!

* 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 *

Relationship to student*

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*

Relationship to Student*

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. Class placement is at the discretion of our Creative Team & correct placement is vital to the growth of your dancer. In event that we need to adjust your class selection, a member of our team will reach out.

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

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

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

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

I acknowledge that I or my son/daughter have voluntarily applied to participate in dance classes, rehearsals, and performances with DancExplosion Arts Center, LLC. Furthermore, I understand the risks associated with physical movement including dance & tumbling.

I've read the above and agree.

Release of Liability

I hereby agree to assume all risks attendant upon myself and/or my child while participating in any class at DancExplosion Arts Center, LLC. I hereby waive, release, and discharge any and all claims for damages for death, personal injury or property damage which I or my child may have, or which may hereafter accrue to me or my child, as a result of my child’s participation in any class at DancExplosion Arts Center, LLC as well as the staff and affiliates of DancExplosion Arts Center, LLC.
I agree to save and hold harmless from liability DancExplosion Arts Center, LLC. and any of their teachers or volunteers by reason of death, injury or damages to persons or property, which my child or I may suffer while participating in class.

I've read the above and agree.

Payment Policy

Tuition is an annual fee divided into ten equal monthly payments. Tuition is due the 1st of the month & courtesy of payment until the 10th. Following the 10th of the month, there is a $10 late fee.
In order to withdrawal from a class, please do so before the next billing cycle.

I understand that DEAC, LCC tuition accounts must be paid in a timely and efficient manner on a monthly basis.

I've read the above and agree.

Video & Photograph Release

I understand and agree that DancExplosion Arts Center, LLC reserves the right to take and use videos and photos of participants, free of charge, to be used for publicity purposes in DEAC's annual dance recital program, other media publications, advertorials, social media and marketing.

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*

Membership Type*

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