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 virtual dance camps or dance classes. Note there is NO registration fee due! You will however be required to pay the tuition fee upfront. Once your online-registration is received, we will process your payment for tuition using 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 hereby assume all of the risks of participating in any/all activities associated with participating in virtual online dance instruction offered by In Motion Dance Studio, Inc or its instructors, employees, or owners. I understand dance involves risk, and I will assume any risks that may arise from negligence or carelessness on the part of the persons or entities being released, because of their possible liability without fault.

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.

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