Thrive Dance Company Online Registration

Registration

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Welcome to Thr!ve Dance, tumble and cheer registration! Please complete all required fields to register. A Registration Fee of $35 will be charged following submission of this form and annually. This will secure your child(ren)'s placement in the classes selected. Thanks!

* 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)*

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

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

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please click on search which will cause a pop-up to display where you can select the appropriate recreational classes of your dancer(s). If your child takes multiple recreational classes, click on search by Class #2 and select the appropriate additional recreational class that your dancer is attending. Continue moving down the list of Class numbers until you have selected all of your classes.

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

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Voluntary Hold Harmless Agreement

THR!VE Dance has made available its facilities in Evansville, Indiana for private use for a voluntary sports/social activity. This is a purely voluntary activity, and you have voluntarily chosen, without pressure or compulsion, to be involved in this activity. By agreeing below, you expressly understand and agree to the terms of this Agreement.

You do hereby indicate your full understanding that the sport/social activity you and your child/children are to engage in may present the possibility for personal injury or damage to you, your child, or your property. You also understand that the facility contains certain items which could present a danger if not properly used or maintained. You hereby indicate that you understand the associated risks and that you are assuming and accepting full responsibility for those risks.

Understanding the potential dangers inherent in any such physical activity or the use of such a facility, you hereby accept those potential dangers, and hereby agree to hold harmless THR!VE Dance, its owners, employees and volunteers, and all persons associated with this event, from any and all liability, claim, demand, or cause of action which you may have on behalf of yourself or your child/children associated with this event, or occurring while on the premises.

By agreeing below, you are indicating your full understanding and agreement that THR!VE Dance, its owners, employees, volunteers, or other persons supervising this event, shall have no legal liability for any injuries, loss, or damage to persons or property which may occur during the event.

Your further agree and hereby state that your child/children is/are in a reasonable state of physical condition such that they can safely take part in this activity.

For Valuable Consideration, the undersigned and their heirs and assigns, agrees to forever release, discharge, indemnify, defend, and hold harmless THR!VE Dance, its owners, employees, volunteers and agents, and the supervising personnel, from any and all claims or damages for personal injury, death, or property damage arising out of the child's participation in these voluntary activities, whether caused by the acts or omissions of the undersigned's or any other party while involved and participating in the activity.

I've read the above and agree.

Financial Agreement

Monthly Tuition will be debited from your bank account or charged to your credit card on the 1st business day of each month. To remove your child(ren) from a class following registration, you must notify the front desk in person by filling out a drop form prior to the 1st of the month you wish to drop. Once monthly fees are processed, tuition will not be refunded for dropping a class. All charges will appear on your bank statement or credit card statement as being from Thrive Dance Company. If the transaction cannot be processed, the family will receive an email notification of the decline. The family can then modify their card data within the Thr!ve Dance Portal and reprocess or bring cash to cover the Tuition amount by the 7th of the month during the published office hours. If the tuition is not paid by the 7th, a Late Fee of $25 will be assessed. If tuition is not paid by the 14th day of the month, the student(s) will not be able to attend classes until the past due tuition is paid in full. A $35 registration fee is assessed at the time of enrollment and each year thereafter, a $35.00 fee will be charged to maintain yearly membership at Thr!ve.

I've read the above and agree.

Media Release

The school is hereby granted permission to use photographs and/or videos of the students in brochures, websites, posters, advertisements and other promotional materials the school creates. Permission is also hereby granted for the school to copyright such photographs/videos in its name.

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*