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Referral Information
How did you hear about us?
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Family Information
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Where do you live?
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Additional Info
Emergency Contact Info
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Contact #1
Contact #1 First Name
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Last Name
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How Can We Contact You?
Home Phone
Work #
Cell #
Portal Access (your email is your login)
Email
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(Emails are kept confidential)
Confirm Email
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Portal Account Password
Confirm Portal Account Password
Student #1
Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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(format=mm/dd/yyyy)
Cell #
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
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Adult X-Large
Child Large
Child Medium
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Child X-Large
Child X-Small
School
Grade Level
preschool
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4th grade
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6th grade
7th grade
8th grade
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college
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Unknown value
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Student #2
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Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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(format=mm/dd/yyyy)
Cell #
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
School
Grade Level
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Student #3
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Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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(format=mm/dd/yyyy)
Cell #
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
School
Grade Level
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Student #4
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Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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(format=mm/dd/yyyy)
Cell #
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
School
Grade Level
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Student #5
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Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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(format=mm/dd/yyyy)
Cell #
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
School
Grade Level
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Add Another Student
Required Policies and Agreements
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Approval Required
I understand that by enrolling a student with the studio I am agreeing to pay a $30 registration fee per student. I understand that students are not enrolled in classes until approval of enrollment is sent by the instructor of the class or the director of the studio.
I've read the above and agree.
Expectations and GuidelinesÂ
I understand that Expectations, Release from Liability and Photo Release sections listed in the
The Dans Company Expectations and Guidelines
document must all be signed before dances are permitted to participate in classes.
The Dans Company Expectations and Guidelines document can be downloaded here.
I've read the above and agree.
Payment
I understand the monthly fees will be due on the first class period of each month. There will be a fee applied to returned checks equivalent to that of
the financial institution. There will be a fee applied to the student's account if it is past due. Each day will add $5 to the balance.
You can pay ahead at any time. Please speak with Amanda, before the payment is due, if there is a problem fulfilling the balance.
I've read the above and agree.
I Agree to All of the Above
Enter your Full Name
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Questions or Concerns
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Payment Information
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eCheck/Bank Draft
Bank Name
Account Type
Checking
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Your Account Name
(Your name on your bank statement)
Bank Routing Number
(9-digit number)
Account Number
