Soul2Sole Dance, Inc. Online Registration

Registration

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Thank you for choosing Soul2Sole as your dance studio! Your business is greatly appreciated! All families must fill in the information below and agree to the waiver.

* 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

Current, New or Old Student?*

Payment? (1x/3x per session)*

Cash, Check, Credit Card?*

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

Please select your classes below. You can filter by location, type of dance class, day, and/or teacher. You can also type in your child's age to see only those classes that are for that age. Please sign up for the classes that correspond with your child(ren)'s age and level.

Enroll in Classes

Select Class

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

Select Class

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

Select Class

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

Select Class

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

Select Class

Add Another Student

Required Policies and Agreements

Waiver & Release of All Claims

I, as the legal parent or guardian of the child[ren] listed on the Soul2Sole Dance, Inc. 2018-19 registration form, have chosen to have my child[ren] participate in dance instruction and/or programs at Soul2Sole Dance, Inc. I acknowledge that I understand the nature of the activities my child[ren] will be participating in and that my child[ren] is/are in the proper physical condition and capable of participating in the related activities, understanding that Soul2Sole Dance, Inc. is not in any way responsible for making such a determination. I also give permission to Soul2Sole Dance, Inc. to seek medical treatment for my child[ren] in the event they are not able to reach a parent or guardian.
In consideration of my child[ren]'s enrollment in any dance instruction or program, I understand and agree on behalf of myself and my child[ren], to release, hold harmless, and discharge Soul2Sole Dance, Inc., its owners, officers, staff, employees and independent contractors from all claims, costs, liabilities, expenses or judgments, including attorneys' fees and court costs for any occurrences in connection with any dance instruction or programs at Soul2Sole Dance, Inc. I assume all risks to my child[ren] in connection with any instruction or participation in programs and further release Soul2Sole Dance, Inc., its owners, officers, staff, employees, or independent contractors from any li-ability for any injury sustained by my child[ren] while he or she is enrolled in any dance instruction or program, including all risks reasonably connected with such activity whether caused by negligence or any other cause foreseen or unforeseen.
I understand that Soul2Sole Dance, Inc. is not responsible for my child[ren] or other children under my supervision who are left unsupervised in the common areas and areas surrounding the dance studio.
I understand that Soul2Sole Dance, Inc. is not responsible for personal property that is lost, damaged or stolen while I or my child[ren] is on Soul2Sole Dance, Inc. property.
I authorize and agree that Soul2Sole Dance, Inc. may take and use photographs, videos or likenesses or my child[ren] as needed for its record-keeping, advertising, social media, and/or public relations projects and that I have no rights to the same and will not be compensated for the same.
My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuant to the terms herein, and agreement as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation.
I HAVE FULLY INFORMED MYSELF AS TO THE CONTENTS OF THIS WAIVER AND RE-LEASE AND HAVE READ THE SAME PRIOR TO SIGNING.
I understand that my child[ren] will not be enrolled in any class[es] or programs at Soul2Sole Dance, Inc. without this signed Waiver and Release of All Claims form.

I've read the above and agree.

Payment Information

Parent(s) and/or care giver must agree to follow all studio policies and understand that registration will not be accepted without parent signature on registration form and studio waiver. For a full list of Soul2Sole Dance, Inc. policies, please visit the website at www.soul2soledance.com.

Photo/Video Waiver & Release:

Soul2Sole Dance, Inc. will take photos and video footage of classes, special events, and camps. By signing the registration form, you are giving Soul2Sole Dance, Inc. permission to use these photos and video footage in brochures, advertisements, social media, and on the studio website.

Soul2Sole Dance, Inc. is a NUT FREE ZONE. Please refrain from bringing any nut products into the studio. Upon registration, Soul2Sole Dance, Inc. must be notified about any medical conditions that might require special attention by the studio staff. All information will remain confidential.

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*