Dance Center of LaGrange Online Registration

Registration

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Welcome to Dance Center of LaGrange! Please complete the following registration form.

* 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*

Click to Enter an International Number

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Home Phone

Click to Enter an International Number

Work #

Click to Enter an International Number

Cell #

Click to Enter an International Number

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 #

Click to Enter an International Number

Additional Info

Student Email

Grade Level*

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

Enroll in Classes

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Click to Enter an International Number

Additional Info

Student Email

Grade Level*

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

Enroll in Classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Click to Enter an International Number

Additional Info

Student Email

Grade Level*

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

Enroll in Classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Click to Enter an International Number

Additional Info

Student Email

Grade Level*

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

Enroll in Classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Click to Enter an International Number

Additional Info

Student Email

Grade Level*

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

Enroll in Classes

Add Another Student

Required Policies and Agreements

Registration Fee

I agree to the non-refundable registration fee of $25.00 per family that will be charged at the time of registration. I give Dance Center of LaGrange permission to charge my credit card/bank account for the registration fee in addition to the class tuition fee(s).

I've read the above and agree.

Tuition & Billing

I am aware Dance Center of LaGrange will send me an invoice, via email, 10 days prior to the beginning of the upcoming session. If I wish to continue in the upcoming session, no action is required. I give Dance Center of LaGrange permission to charge my credit cards/bank account automatically on the tuition due date.
A $10.00 late fee will be assessed for all tuition payments that are declined. No refunds are offered once tuition has been paid.

I've read the above and agree.

Missed Classes

No credit or refund will be given for missed classes. Classes must be made up within the same session. Those which fall on legal holidays must be made up in other scheduled classes. Finding an appropriate make-up class is the responsibility of the student.

I've read the above and agree.

Canceled Classes

Dance Center of LaGrange reserves the right to cancel classes and will issue refunds in this case only. No other refunds will be given.

I've read the above and agree.

Class Observation

Observation of any class is by appointment only and must be arranged in advance. A parent or legal guardian must accompany children under the age of 18. Consent of the instructor is necessary for all observations. There will be regularly scheduled observation days

I've read the above and agree.

Contact & Billing Information

I understand if any of my contact information should change, especially my email address, I will contact the studio to provide this new information for billing and mailing purposes. Dance Center of LaGrange does not send junk emails; if we send you an email, it is your responsibility to read it as it will pertain to your dancer and/or their class.

I've read the above and agree.

Release of Liability

As the legal parent or guardian, I release and hold harmless Dance Center of LaGrange, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant while in or upon the premises or any premises under the control and supervision of Dance Center of LaGrange., its owners and operators or in route to or from any of said premises.

I've read the above and agree.

Photography/Video Release

All images taken by the Dance Center of LaGrange are subject to use for advertising purposes without royalty. Parent/Guardian agreement constitutes the release of such photographs/videos.

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*