Releve Dance Academy Online Registration

Registration

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Welcome to Registration

* 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)

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please select the classes you would like to attend. If you do not see the class/time you would like please contact the Director.

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please select the classes you would like to attend. If you do not see the class/time you would like please contact the Director.

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please select the classes you would like to attend. If you do not see the class/time you would like please contact the Director.

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please select the classes you would like to attend. If you do not see the class/time you would like please contact the Director.

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please select the classes you would like to attend. If you do not see the class/time you would like please contact the Director.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Tuition

2019-2020 schedule tuition will be paid by the 5th of each month from September-May. All late accounts will be subject to a $25 late fee. All fees are non-refundable. If you must withdraw your student from a class please contact the studio a minimum of 2 weeks prior to the next tuition date, if not you will be charged the following months tuition.

I've read the above and agree.

Photo Release

I hereby allow Relevé Dance Academy to use my students photo on the studios social media (facebook.com/relevedancenh /instagram @relevedancenh ) and website (relevedanceacademynh.com) .
(If you have any concerns with this please let Miss Dana know in the comments.)

I've read the above and agree.

Dress Code

Students must follow the dress code, or they may be asked to leave the class. Hair must be pulled up and out of the face. No jewelry may be worn while dancing.

I've read the above and agree.

Injury

Due to the physically active nature of dance lessons we need expressed permission for your child to participate in our dance classes. Waiver Of Liability: I hereby give permission for son/daughter/ward to participate in Relevé Dance Academy classes and will not hold responsible either the directors, teachers, or teaching assistants for any accidents or injury which may occur in relation to the dance lessons.

I've read the above and agree.

Behavior

All students must be polite and respectful to each other and their teachers. If a student is disrespectful, the teacher has the right to ask the student to leave the classroom. No cell phones are to be used in class. All phones must be on silent or turned off.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule

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