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 a dance class. Payments will be processed using the credit card you provide.

* 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 *

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*

Special Needs

Allergies

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

School

Grade*

Special Needs

Allergies

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

School

Grade*

Special Needs

Allergies

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

School

Grade*

Special Needs

Allergies

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

School

Grade*

Special Needs

Allergies

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 my tuition payment will be processed once my registration form is approved. Payment will be processed using the billing information I provided with this registration.

I've read the above and agree.

Other Studio Policies

I understand that my child is expected to attend class regularly and on time. If my child arrives more than 15 minutes late to class, she/her will be asked to observe class instead for safety reasons.
I understand that my child needs to follow the studio dress code and have hair up before she enters the classroom.

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*