Urban Dance Connection Online Registration

Registration

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Welcome to Urban Dance Connection! 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*

Province*

Postal Code*

Home or Primary Phone*

Additional Info

Emergency Contact Info
(Not Contact #1 or #2)*

Photo and Video release Y/ N *

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

T-Shirt Size

Disabilities (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

Disabilities (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

Disabilities (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

Disabilities (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

Disabilities (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

RELEASE STATEMENT

I hereby release URBAN DANCE CONNECTION, employees, contractors & agents from any liability arising out of or in any way connected with participation of myself, my son or daughter program activities. I authorize URBAN DANCE CONNECTION in event that I cannot be reached by telephone at the listed numbers above to transport and admit child to local hospital for the purpose of emergency medical treatment.I release said organizations, their employees, contractors and agents from any liability incurred for the transportation and admission of my child to a local hospital for emergency medical treatment.

I've read the above and agree.

CANCELLATION POLICY

The participant agrees that they have registered for the aforementioned dates and understands that there will be no refunds on registration and costume fees. I understand that there is a one month written notice required in the event that I cancel participation at URBAN DANCE CONNECTION for any reason prior to or during the season.
Competition and Company Programs are a full years commitment as they are team based.No refunds will be given to these programs.

I've read the above and agree.

NSF / LATE FEES

All NSF cheques or credit cards will incur at $25 fee payable immediatelyupon request. Payments in arrears will incur a $20 late fee per month.Payments in excessive arrears will be sent to collections.

I've read the above and agree.

PHOTO / VIDEO RELEASE

URBAN DANCE CONNECTION uses photographs and video in its promotional materials and publicity efforts or other types of promotion from time to time as well as the taping of the year end recital .Please fill in NO on the registration form if you do not want your child filmed or photographed (UDC will then contact you before recital to make arrangements for the filmed recital to ensure your child isn't in the year end video if thats your families wishes).If left blank it will be automatically assumed that the photo/video release is accepted.

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

Country

City

Province

Postal Code