The Movement Dance Studio Online Registration

Registration

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We want to know what moves you | M O V E M E N T | More than just dance - lifestyle

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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

Parent Contact First Name*

Last Name *

Type

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Dancer's Email

Grade Level*

Special Needs

Allergies

Medications

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Dancer's Email

Grade Level*

Special Needs

Allergies

Medications

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Dancer's Email

Grade Level*

Special Needs

Allergies

Medications

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Dancer's Email

Grade Level*

Special Needs

Allergies

Medications

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell # Receive Text Message Notifications

Additional Info

Dancer's Email

Grade Level*

Special Needs

Allergies

Medications

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Enrollment

Enrollment in a class or classes requires full payment of a non-refundable $40 registration fee for returning students and $50 for new students, recital program and the rest month's tuition. The Movement Dance reserves the right to cancel any class due to/or as a result of insuf cient enrollment, inclement weather or additional circumstances deemed necessary by management. The Movement also reserves the right to switch class instructors at any time during the year if necessary.

I've read the above and agree.

Tuition

TUITION: Tuition is paid monthly from August through our year-end recital. Tuition is paid monthly to hold a student's place in a class or classes, and must be paid regardless of the student's attendance each month. Some months will have weeks of class while others have less; however, monthly tuition will remain the same. Tuition has been determined for the entire studio year and divided into monthly payments. Please remember you will
not be sent a statement. Since tuition is paid for the space in the class, please do not ask for a reduction. Tuition is due on the 28th of each month and considered past due if not paid by close of business on the 5th of the month. A $30 late fee per student will automatically be billed to all late accounts on the 6th of each month. If tuition becomes two months delinquent the credit card on file will automatically be charged. If the card is declined, the students are subject to removal from classes. We no longer accept checks for payment; please use cash, debit or credit cards only.

I've read the above and agree.

Safety

We are not responsible for students before and after their designated class time or once they exit the building. Please instruct your child to remain inside the building for the duration of their time before picked up from The Movement Dance Studio. Students should be dropped off no more than 5 minutes before class and promptly picked up after class. No one under the age 12 is allowed to leave the building without adult supervision. Please note - our classes dismiss 5 minutes before the hour, or half hour to allow for staff and students to change rooms when necessary.

I've read the above and agree.

Studio Closures

The Movement observes closures during the following Holidays:
Labor Day, Thanksgiving, Christmas, New Years, Spring Break, and Memorial Day.

You can always find our closed or important dates on our website or social medias.

I've read the above and agree.

Agreement

In consideration of your acceptance of the enrollment, I, intending to be legally bound, do hereby waive, release and forever discharge all rights and claims against THE MOVEMENT DANCE, Inc., and/or any involved personnel for damages or injury sustained by me or my child in classes or on studio premises before or after class, or at any other outside studio activities, including recitals, workshops, performances or visits to surrounding businesses.
I authorize THE MOVEMENT, Inc., to use photos and videos taken of my child while at dance or dance functions, for marketing and promotional material.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

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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*