Carolina Dance Capital Online Registration

Registration

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WELCOME TO CAROLINA DANCE CAPITAL

* 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*

Health Insurance Carrier

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

Type

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)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Add Another Student

Required Policies and Agreements

Hold Harmless Agreement

I have full knowledge that by nature class participation can frequently include exercise and body contact along with associated dangers.

In recognition of the possible dangers connected with any physical activity, students hereby knowingly and voluntarily waive any right of cause of action and any kind whatsoever arising as a result of such activity from which any liability may or could occur to Fritz & Annette Schulte, its officers, agents, or employees or instructors.

I agree to waive claims against any person or organization connected with Star Dance Production LLC/Carolina Dance Capital for ny injuries I may sustain and likewise assume full responsibility for all my actions in connection with said classes.

I understand that Star Dance Production/Carolina Dance Capital and its agents urges for all students to obtain a physical examination from their physician prior to attending any class.

I've read the above and agree.

Image Release

I hereby grant permission for videos and photographs to be taken during class time and other performances. I understand that this media will be produced and used for advertising purposes and all social media. I authorize Star Dance Production/Carolina Dance Capital to use my photograph or video on their website, printed material and/or all social media without further consideration. I also acknowledge that Star Dance Production/Carolina Dance Capital may not choose to use my photo/video at this time, but do so at it's own discretion or at a later date. I also understand that there is no compensation for this media.

I've read the above and agree.

Social Media

Social media "bullying" in NC is considered a Class 1 misdemeanor if over 18 years old, and a Class 2 misdemeanor if under the age of 18. I understand that if I am found (or my child) to be using social media inappropriately I (or my child) will face consequences that might result in dismissal from Carolina Dance Capital. The studio only supports positive and encouraging social media.

I've read the above and agree.

Tuition Payments

All tuition will be charged to the credit card number or bank account number in your customer portal on the first of each month. Accounts not paid by the 10th of each month will reflect an additional $10 late fee. If a balance is carried over to the following month a $20 carry-over fee will be added.
Tuition remains the same regardless of how many classes a student misses.

I've read the above and agree.

Payment Policies

Summer Tuition Refund Policy: Tuition refunds are offered in full if a recreational class or camp does not meet its minimum enrollment. Refunds are not available should your summer plans change after you have registered and paid the tuition fee.
2018/2019 Season Policies:
*Please see our Studio Policies for a complete list of our current policies. All classes (except adult classes and classes starting in January) are recital classes and all students will participate in Carolina Dance Capital's annual recital.
Visa, MasterCard, Discover or bank account information is required for registration. Make sure to fill out all respective fields with payment information at the bottom of this page. Registration fees are nonrefundable and non-transferrable.

I've read the above and agree.

NSF Fee

A $35 service charge will be applied to your account when a check, electronic check or credit card draft is returned for any reason.

I've read the above and agree.

Automatic Draft

I authorize Star Dance Production d.b.a Carolina Dance Capital (CDC) to use the credit card number and expiration date, or bank account information, I've provided online via the CDC Customer Portal. I understand that this card or bank account will be used to make payment on all of my dance fees on their respective due dates. This includes, but is not limited to, registration fees, monthly tuition, costume deposits & balances and recital packages. I understand that payment of all fees is my responsibility, and that a $35 declined draft fee will be applied to my account if the card on file or bank account draft is declined and cannot be processed for any reason. I further understand that it is my responsibility to maintain a valid credit card number and expiration date in the Customer Portal, and that any changes or updates must be made by me through the Portal. No changes or updates will be accepted by phone or at the studio.

I've read the above and agree.

Online Credit Card/Bank Draft Policy

Visa, MasterCard, Discover or Bank Draft information is required for registration. If you are registering for the Summer 2018 Session, your credit card/bank account will be charged the $25 summer registration fee and appropriate 9 week summer tuition fee only. If you are registering for the 2018/19 Season, your credit card or bank account will be charged the $50 registration fee. Make sure to fill out all respective fields with payment information at the bottom of this page for registration to be valid. Registration fees are nonrefundable and non-transferable.

I've read the above and agree.

Electronic Signature

I understand that submission of this online registration includes my electronic signature and that my electronic signature requires my understanding and acceptance of ALL of Star Dance Production/Carolina Dance Capital Studio Policies and conditions, including those provided on our website. Parents of competitive students acknowledge that there will be additional policies that they will need to sign separately at a later date.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

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

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