Dance Center of Kirkwood Online Registration

Registration

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Welcome to Dance Center of Kirkwood! Please complete the following registration form. If you have questions, call Betty at (314) 821-6663.

* 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)

Cell #

Additional Info

Student Email

Grade Level*

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)

Cell #

Additional Info

Student Email

Grade Level*

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)

Cell #

Additional Info

Student Email

Grade Level*

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)

Cell #

Additional Info

Student Email

Grade Level*

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)

Cell #

Additional Info

Student Email

Grade Level*

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

Dance Center Basic Policy

I understand that dance classes and performances may include stretching, barre work, across the floor combinations, dance routines in the center, and other related activities. I further understand that all of the activities of the dance class involve some degree of risk of strain or bodily injury.
If there is a health issue that the teacher should be aware of, please inform the teacher in case she would need to modify her teaching plan.
In case of illness, you may make up that class in any other class of that level.
Parking: Dance Center families will now have to park in the back parking lot. Please remind and insist that your children do not wait outside for you.

I've read the above and agree.

Dress Policy

We request that dancers observe our dress code:
All dancers must wear a cover-up (street clothes) over their dance wear when coming to and from the studio.
Predance 1 through Dance 3: black leotard, pink tights, pink ballet shoes, black tap shoes (ballet skirt optional), hair pulled back off the face in ponytail, bun, etc.
Dance 4, Dance 5, Dance 6: black leotard, pink footed or convertible tights, pink ballet shoes. Oxford style Tap shoes, black slip-on Jazz shoes, Dance 5 & 6 Jazz and Tap classes can wear suntan tights with dance shorts.
Ballet 1, 2 and 3: black leotard, pink convertible tights, ballet skirt optional, hair in a bun.
Jazz and Tap 1, 2 and 3: black leotard, pink or tan tights, ballet skirt or shorts optional, black slip-on Jazz shoes, black Oxford Tap shoes.
Modern 1, 2 and 3: black leotard, tan footless or convertible tights, dance skirt or shorts optional, no shoes.

I've read the above and agree.

Recital Deposit

Due to the price increase of the new Chaminade venue, families that will participate in the June Spring Performance (recital) will now have to pay a small recital fee. Families in Predance 1 through Dance 5 will pay a $35.00 recital fees and families in Dance 6 will pay $50.. Families in Ballet, Jazz, Tap and Modern 1, 2 and 3 will pay a $75.00 recital fee. Then we will reduce the price of the recital tickets from $17 to $10.

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number