J & D Dance Academy Online Registration

Registration

Welcome to J & D Dance Academy's online registration. Please complete the form and click submit. Annual Registration Fees: $35/family (There is no registration fee for the Summer Dance Camp or Summer Intensive.) After submitting this form, you will receive an invoice via email. This may take up to 5 business days. Your spot in the class will be confirmed once Registration fee payment is received; please send this in after you complete this form. September tuition is due on September 1.

* 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

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

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)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Previous Training

Please select the class(es) in which you'd like to enroll. You will see a magnifying glass in the top left corner. Click this icon to filter the class listings.

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

Previous Training

Please select the class(es) in which you'd like to enroll. You will see a magnifying glass in the top left corner. Click this icon to filter the class listings.

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

Previous Training

Please select the class(es) in which you'd like to enroll. You will see a magnifying glass in the top left corner. Click this icon to filter the class listings.

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

Previous Training

Please select the class(es) in which you'd like to enroll. You will see a magnifying glass in the top left corner. Click this icon to filter the class listings.

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

Previous Training

Please select the class(es) in which you'd like to enroll. You will see a magnifying glass in the top left corner. Click this icon to filter the class listings.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

HEALTH/WAIVER OF CLAIMS/CONSENT: I warrant that I have no disability, impairment or ailment that prevents me from engaging in the activities herein described. This representation is made by me knowing that J & D Dance Academy of Reading will rely upon it in allowing me to participate in studio activities. I expressly agree that my use of and/or attendance at the Academy are undertaken at my sole risk and that the Academy's owners, managers and employees shall not be liable for any damages or injuries to me or my property or be subject to any claim, demand or cause of action, including for any injury or damage resulting from then negligence of the Academy, its Management of other Academy guests. I consent to pictures being taken of me by the Academy for advertising purposes and website use only and understand that such pictures will become the property of the Academy. Where the participant listed above is a Minor (under 18 years old), I, as the minor's parent or legal guardian, expressly agree to the Health/Waiver of Claims/Consent provisions contained below. I authorize the Academy and its Management to obtain medical treatment for my dependent minor.

I've read the above and agree.

Release of Liability

I am aware of the risk of physical injuries associated with dance, including the stresses on the body associated with repetitive exercise and movement. I assume these risks and shall not hold J & D Dance Academy, its faculty, chaperones or agents liable in any way for injuries sustained while attending class. I assume responsibility for my child's health during the course of the program and will notify faculty if my child's health status changes as well as any relevant medical conditions, including known allergies and other physical limitations which might affect my child's safety or achievement.

I've read the above and agree.

Payment Policies

REFUND POLICY: Tuition is collected monthly and quarterly. Should a student leave part way through, the unused portion will be refunded. Please approve Health Waiver and Consent form in order to complete registration. J & D Dance Academy reserves the right to cancel said program due to enrollment, full refunds will be issued.

I've read the above and agree.

Medical Emergencies

I give my permission for my child to be treated for emergency medical care, if warranted. Every attempt will be made by the school to contact me regarding any such case. I have provided up-to-date medical information about my child and pertinent contact information.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments