Centre Dance Online Registration

Registration

Already a customer? Click here to login.

Welcome to Centre Dance Enrollment! Please provide your information below and click "Submit". Credit Cards will only be charged a $40/student nonrefundable deposit at this time. Tuition amounts do not include any discounts (10% off if student is enrolled in more than one class, 5% off for 2 or more students taking 3 or more classes each)

* 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*

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

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

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

I am the parent/guardian of the dancer(s) listed on this page, a minor, who is enrolled as a student in a course of instruction in dance with the studio of Nicole R. Swope, t/a CENTRE DANCE, of State College, Pennsylvania. By enrolling the minor in his course I certify that I am aware of the possibility of injury in connection with the activities connected therewith. I understand and agree that neither the owners, operators, agents or instructors, including but not limited to Nicole R. Swope, may be held liable in any way for any occurrence in connection with the dance studio which may result in injury or other damages to the minor, me or the minor's family heirs or assigns.

In consideration of the minor being allowed to enroll in this course, I hereby personally assume all risks in connection with the course, and I further release the instructors, program agents, and operators, including but not limited to the persons mentioned, of any injury or damage which may befall the minor while the minor is enrolled as a student of the school, including all risks connected therewith, whether foreseen or unforeseen; and further, to save and hold harmless the program and persons from any claim by or on behalf of the minor or the minor's family, estate heirs or assigns, arising out of the minor's enrollment and participation in the course.

I further state that I am of lawful age and legally competent to sign this affirmation and release that I understand the terms herein are contractual and not mere recital; and that I have signed this document as my free act.

I have fully informed myself of the content of this affirmation and release by reading it before I signed it electronically.

I've read the above and agree.

I have understand and agree to follow the policies of Centre Dance as stated in the Parent/Student Handbook, which can be found at www.centredance2121.org

I've read the above and agree.

I agree that I am financially responsible for the to pay monthly tuition, costume fees, any late fees that I incur, and any other associated with dancing at Centre Dance. I understand that there are no refunds, credits, or deductions for classes missed or discontinued. I may, however, make up any missed classes within a one-month period. I understand that I may discontinue my classes and financial obligation to Centre Dance at any point in the year by notifying Centre Dance in writing. Please note that you must contact Centre Dance in writing prior to the 7th of the month or you will be responsible for that month's tuition and any fees incurred. If you do not notify Centre Dance in writing, you remain responsible for all fees incurred until you do so.

I understand that ALL Centre Dance students must have a credit card on file with the studio. If a payment is not paid to the office by the due date, my credit card on file will be charged the following day for the full amount.

I've read the above and agree.

I know and understand that it is my responsibility to check the email that I provide to Centre Dance and the Centre Dance website (www.centredance2121.org) regularly for updates and important information.

I've read the above and agree.

I check this box understanding that Centre Dance has permission to post pictures and/or videos of my child unless I send Centre Dance an email stating that I do not give them permission for this. I also understand that these photos/videos will only consist of photos/videos that pertain to Centre Dance.

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*