Spotlight Dance Center Online Registration

Registration

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Welcome to Spotlight Dance Center! Please complete the following registration form.

* denotes required fields

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 *

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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

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

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Liability

Precautions have been taken to ensure a safe, comfortable environment for your child's experience at Spotlight Dance Center. Spotlight Dance Center is not responsible for bodily injury occurring to my child while on the premises. It is imperative that my child follow the teacher's instructions at all times. I understand and accept that due to the inherent nature of dance and dance movements, sometimes a sprain, bruise or other injury may occur. I hereby agree to hold Spotlight Dance Center and its staff harmless against liability, loss, expenses, damages and injury claims while on the premises of the studio.

I've read the above and agree.

Photo/ Video

I give Spotlight Dance Center permission to use my child's photo/video or advertising purposes in print or on the website.

I've read the above and agree.

Studio Policy

I have read/received a copy of Spotlight Dance Center's studio policy and understand all of its content and guidelines. I understand that I am responsible for the monthly tuition unless I notify the studio that my child has discontinued. My child and I understand all rules pertaining to dress code, classroom and waiting room behavior.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

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