Miss Tanya's Expression of Dance, Inc. Online Registration

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Miss Tanya's Expression of Dance

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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 *

Type*

How Can We Contact You?

Home Phone

Work #

Cell #

Portal Access (your email is your login)

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Confirm Email*

Portal Account Password

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Contact #2

Contact #2 First Name

Last Name

Type

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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)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

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Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

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Student Gender*

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

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Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

T-Shirt Size*

Enroll in Classes

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

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Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

T-Shirt Size*

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)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

T-Shirt Size*

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)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

T-Shirt Size*

Enroll in Classes

Select Class

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Required Policies and Agreements

Enrollment Agreement Terms

I/We know that participation in dance or gymnastics may result in serious injuries and do hereby waive, release, indemnify, and agree to hold harmless Expression of Dance, Inc., the owners, officers, instructors, and all employees from any claim arising out of any injury to my child while he or she is participating in any class, rehearsal, competition, show, or related activity that is sponsored or conducted by Expression of Dance, Inc. or any of its representatives whether the result of negligence or for any other cause.
I/We understand that Expression of Dance, Inc. will not provide any form of accident insurance policy to provide medical coverage for any student. I/We will assume ALL FINANCIAL RESPONSIBILITY for any injuries that may require medical treatment.
I/We understand that I/We are fully liable for the entire cost of the recital costume if my child elects to participate in the recital (for September - June session). This includes if the child drops a class and costumes have been ordered, and includes all competition costumes if applicable. I/We understand the costume will be sent home upon arrival and I/We are fully responsible to pay off the costume in full by the deadline.
I/We have read completely the EOD Tuition policy and the Rules & Procedures, as listed on our website. I understand & agree to comply with all of EOD's policies. Furthermore, I give EOD permission to release pictures taken of my child for use on EOD's website, newspaper advertisements & marketing materials.

I've read the above and agree.

Credit Card Agreement Terms

I/We understand that my credit card will be charged for my tuition fee and registration fee (if applicable) upon registering for classes.
If my credit card is declined at any time, a $5.00 declined credit card fee will be applied to my account.

I've read the above and agree.

I Agree to All of the Above

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Questions or Concerns

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Exp Year *

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