Dance Works Studio Online Registration

Registration

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Please Check all the Classes you would like to be in!

* 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 *

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies*

If unsure of what level class to register for, feel free to contact us at dwsconnect@yahoo.com for advice or choose the appropriate level if you already know. We will further advice if placed incorrectly.

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

Disabilites

Special Needs

Allergies*

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

Disabilites

Special Needs

Allergies*

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

Disabilites

Special Needs

Allergies*

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

Disabilites

Special Needs

Allergies*

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Agreement

authorize Dance Works Studio to enroll me/my child in dance classes, and I accept responsibility for the payment of registration, tuition, costume, and recital fees for the classes in which I/she/he is enrolled according to the payment schedule for the current year.
- I understand that I need to notify Dance Works in writing when dropping a class mid session (Summer or School year) otherwise I will be responsible for tuition payment until the end of the session. All payments made become non refundable in the case I drop the class mid session.
- I understand that tuition is due by the first of each month and that a $10.00 late fee will be charged for all payments made after the 10th of the month. There will also be a $35 fee for returned checks.
- I understand that the registration fee is non-refundable and that there are no refunds or deductions for classes not attended including classes cancelled due to weather and holidays.
- I understand that no student will be allowed to participate in class if more than 15 minutes late because missing warm up may lead to serious injury. Students are welcome/encouraged to observe class if they are not able to participate.
- I understand that dancing is a sport. Although rare, injuries sometimes occur. I hereby release Dance Works Studio from any liability for any accident or injury occurring on or around studio property or at any function held at other locations is association with the dance class in which I/my child is enrolled. I declare that I/my child am/is in good health and am/is physically able to participate in dance classes. In the event of an injury or emergency when I cannot be contacted, I give permission for Dance Works Studio, Llc to obtain proper medical services for me/ my child.
- I give permission to Dance Works Studio to photograph my child for advertising purposes.

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*