New Canaan Dance Academy Online Registration

Registration

Already a customer? Click here to login.

Welcome to New Canaan Dance Academy! 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*

Additional Info

Emergency Contact Info
(Not Contact #1 or #2)*

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

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*

Student Gender*

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

Additional Info

School*

Grade Level*

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor*

Skill Notes

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

School*

Grade Level*

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor*

Skill Notes

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

School*

Grade Level*

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor*

Skill Notes

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

School*

Grade Level*

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor*

Skill Notes

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

School*

Grade Level*

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor*

Skill Notes

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Summer Intensive Enrollment

Summer Intensive Enrollment is for the week of Monday August 19th to Friday August 23rd.

A $100 deposit per Summer session plus a $10 registration fee per student is due on enrollment, with the balance of the Summer tuition due on the first day of the Intensive.
NCDA accepts payment with credit cards or by check.

I've read the above and agree.

Registration

Registration and enrollment is not complete until a deposit of $100 per Summer session plus a non-refundable registration fee of $10 per student is paid by credit card or check.
Log in to your account, click on the "Billing and Payments" tab, click on "Pay Now", and enter the amount you need to pay for the deposit(s) and registration fee(s) to guarantee your enrollment.
If you are a returning family, please be sure to UPDATE YOUR CREDIT CARD INFORMATION.

All payments may be made directly through your account page if paying by credit card.

I've read the above and agree.

Waivers

Medical
I give permission to New Canaan Dance Academy to seek medical treatment for my child in the event they are not able to reach a parent or guardian, and that I have listed my child's medical conditions that NCDA should be aware of, as well as any medication that my child should be taking.

Liability
I understand that participation in NCDA classes and performances brings the possibility of physical injury to the students, and I agree to assume all risks and responsibilities in the event of any such injuries.

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*