Encore Dance Academy Online Registration

Registration

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Welcome to Encore Dance Academy! Please note that in order to complete your registration and reserve your child's place in class, September's Tuition and Registration must be paid in full. Please allow 3-5 business days for tuition to post to your account and your payment to be processed.

* 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*

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

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

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

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

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

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

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

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

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Medical Release

Encore Dance Academy as well as instructors, contractors, volunteers and staff are not liable for personal injuries or loss of or damage to personal property. I give permission to Encore Dance Academy to provide and/or seek medical attention for my child should medical treatment be required and I will assume all costs of my child/children's medical bill(s). I am hereby waiving and releasing Encore Dance Academy, its owners, employees, volunteers, and contractors from and against any and all claims, cost, liabilities, expenses or judgments including attorney's fees and court costs arising out of participation in the program, or any illness or injury resulting there from and hereby agree to indemnify and hold harmless Encore Dance Academy, its owners, employees, volunteers and contractors from any and all such claims.