Leap of Faith Dance Online Registration

Registration

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Welcome to Leap of Faith Dance! Please complete the following registration form.

* denotes required fields

Referral Information

How did you hear about us?

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)*

Health Insurance Carrier

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)

Additional Info

School

Grade Level

Special Needs

Allergies

Medications

Student Waiver Acceptance Date

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 Level

Special Needs

Allergies

Medications

Student Waiver Acceptance Date

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 Level

Special Needs

Allergies

Medications

Student Waiver Acceptance Date

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 Level

Special Needs

Allergies

Medications

Student Waiver Acceptance Date

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 Level

Special Needs

Allergies

Medications

Student Waiver Acceptance Date

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Attendance Policy

If my student is in attendance less than 70% in the semester they will be required to private lessons from their teacher.
If my student needs to withdraw from classes, I am responsible for tuition in full until the studio office is notified in writing.
Class changes need to be submitted in writing.

I've read the above and agree.

Classroom Policy

Students and Parents will treat and speak to teachers and others with respect.
Students and Parents agree to the "Classroom Attire" requirements.
All students must stay in the dance studio building until parent/guardian arrives to pick their child up. No standing outside the front door.
Leap of Faith reserves the right to dismiss any student due to disciplinary/behavioral problems and no refund will be given.

I've read the above and agree.

Property Policy

While on the studio premises, I will treat others and their property with respect and will maintain control of minors in my care while on site.
I will not slander or gossip about any persons, business, or organization while on the Leap of Faith premise, at any Leap of Faith events, or on any of Leap of Faith social media platforms.
I will treat the studio and its contents with respect and clean up after myself and my children.

I've read the above and agree.

Release Statement

I do hereby release Leap of Faith and their agents or representatives of liability for my child (or myself) of any injury to my child (or myself) in class, while on the school campus, or while participating in performances. I understand that in the event medical intervention is needed, every attempt will be made to contact the person(s) listed on the student's registration form. In the event next of kin cannot be contacted for the health and well-being of my child (or myself), I hereby authorize the Principal or Instructor of Leap of Faith to authorize whatever medical treatment that might be necessary in an emergency situation. I understand that I and my medical insurance carrier are financially responsible for any medical treatment extended to my child (or myself), and that Leap of Faith and its agents or representatives cannot be held accountable or liable for such medical treatment.

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*