Underground Dance company Online Registration

Registration

Underground Dance Company Fall 2019-2020 Classes Begin Wednesday, September 4th

* 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 #

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

T-Shirt Size

Monthly tuition is due the first class of each month $ 15 Late fee applies if tuition not paid by the 10th of the month $ 25 fee for all returned checks There is no reimbursements for missed classes - see teacher for makeup times Payments: Cash or Check only

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

T-Shirt Size

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

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)

Additional Info

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)

Additional Info

T-Shirt Size

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Release / Disclaimer

I, _____________ parent or legal guardian of ________________________ have voluntarily allowed my child to engage in dance and am well aware of any such risks involved with the activity. I agree to hold Underground Dance Company, it members, agents, employees, teachers and staff harmless from any and all claims of every kind or nature arising out of my child/children's participation in the dance instruction. Underground Dance Company has my permission to use videotape or photographs of my child/children in the studio, or promotion of Underground Dance Company. I also agree that if my child no longer wishes to dance, a written notice must be provided to Underground Dance Company or my fees will continue and I will be liable for them. By signing, you agree that you have read and understand the information set forth in this document and that all information you have provide is true to the best of your knowledge.

I've read the above and agree.

Tuition

I am aware that my monthly payments will be the same regardless of how many weeks in a month.
Payments are based on the average number of weeks from September through June.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments