ONE Movement Online Registration

Registration

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Welcome to ONE Movement! Please complete the following registration form.

* 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 *

Type

How Can We Contact You?

Home Phone

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*

Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Please click on the Search button below, then choose the class. Registration Fee Applies for families paying their monthly payments by: Cash, Visa, MC, Debit or Email Money Transfer *families paying by post dated check, registration fee is waved. $40.00 Registration Fee for our Sept-June Programs. $5.00 Registration Fee for our Adult Dance Programs and Day Time Dance Programs.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Liabilitly Release

As a parent/guardian/student 18 +, bringing my child and or attending dance classes with ONE Movement.

I fully understand that my son's/daughter's/my participation in classes with ONE Movement and their company teachers, they/myself may be exposed to a variety of hazards and risks, foreseen and unforeseen, that may include, but are not limited to, personal injury, property damage and death.

To the fullest extent allowed by law, I agree to waive, discharge claims and release from liability ONE Movement, Autumn Fernandes Owner, Artistic Director of ONE Movement, all of ONE Movement's company members/teachers, from any and all liability on account of, or in any way resulting from Injuries or damages.

I understand and intend that this assumption of risk and release is binding.
I hereby certify that I have read, understand, and agreed to the foregoing (and or) allow my above named child/myself to take part in dance classes with ONE Movement.