In Motion Dance Studio Online Registration

Registration

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Welcome to In Motion's on-line registration! Please complete the following registration form to register for one of our new dance classes (offered Feb 8-Mar 14). Note there is NO registration fee due! You will however be required to pay the session cost up front. Once your online-registration is received, we will process your payment for the session cost with the billing information you provide. Thank you!

* 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

Type

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

T-Shirt Size

School*

Grade*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

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

T-Shirt Size

School*

Grade*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

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

T-Shirt Size

School*

Grade*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

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

T-Shirt Size

School*

Grade*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

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

T-Shirt Size

School*

Grade*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Liability Release

I realize that dance and dance related activities involves some risks. In consideration of my/my child's participation in these activities, I release and discharge In Motion Dance Studio, Inc. and instructor's from any and all liability arising from accident, injury, and illnesses that my child/myself may suffer as a result of participation in this activity.

I've read the above and agree.

Photo/Video Release

I hereby give permission for images of my child, captured during regular classes, rehearsals, performances and special activities through video, photo, and digital camera, to be used solely for the purposes of In Motion Dance Studio promotional materials, website, and publications, and waive any rights of compensation or ownership thereto.

I've read the above and agree.

Payment Policy

I understand that upon registration my tuition payment for the 6 week session will be processed for the full payment amount. Office staff will process payment automatically using the billing information I provide, once my online registration form is received.

I've read the above and agree.

Other Studio Policies

1. Students are expected to attend class regularly and arrive to class on time. Students arriving over 15 minutes late to class will be asked to observe class instead, for safety reasons.
2. Students are expected to dress according to In Motion's Dress Code for 2019-2020 year.
3. Young students should never be left un-attended in the studio waiting areas. Parents are expected to escort children in and out of the building if under the age of 12, and wait with them until class time begins.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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