Extensions Dance Company Online Registration

Registration

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Welcome to Extensions Dance Company! 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*

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

Is this unlimited summer?*

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)

Additional Info

Is this unlimited summer?*

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)

Additional Info

Is this unlimited summer?*

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)

Additional Info

Is this unlimited summer?*

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)

Additional Info

Is this unlimited summer?*

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

Enroll in Classes

Add Another Student

Required Policies and Agreements

HEALTH WAIVER

I certify that I/my child/ward am/is in good health and capable of participating in classes and events at and with Extensions Dance Company.

I've read the above and agree.

LIABILITY WAIVER

I recognize and acknowledge that there are certain risks of physical injury to participants in the classes and events at Extensions Dance Company (ExDC) and I agree to assume the full risk of and waive all claims I or my child/ward may have associated with any such injuries, damages or loss which I or my child/ward may sustain as a result of participating in any activities connected or associated with ExDC. I further agree to indemnify and hold harmless and defend Extensions Dance Company and its officers, agents, and employees from any and all claims resulting from injuries, damages and losses sustained by me or my child/ward, arising out of, connected with, or in any way associated with the activities of ExDC. I have read and fully understand the class details and waiver and release of all claims.

I've read the above and agree.

IMAGE WAIVER

By registering for classes and checking the box below, I agree to all policies of Extensions Dance Co. By registering online, I am consenting to my child's image, along with identifying information, to be used in print and video on the studio website, youtube.com, facebook, Instagram, Twitter, newspapers, and any other media format that Extensions Dance deems appropriate.

I've read the above and agree.

PAYMENT

I understand that if I am registering for the 2018-19 season (not just an intensive or CARE) and check the box below I agree to a nine (9) month fee schedule beginning September 15 of this year and ending May 15 of the following year. I understand that all payments are non refundable.

I've read the above and agree.

DRESS CODE

Pre Ballet: Black or Pink leotard, pink tights, ballet shoes, hair neatly pulled back.
Beginning and Intermediate Ballet: Black Leotard, pink convertible tights, pink ballet shoes, alignment belt, hair neatly pulled back.
Advanced Ballet: Solid color leotard, pink convertible tights, ballet shoes. alignment belt, hair neatly pulled back.
Jazz: Tight fitting dance clothes, tan jazz shoes, hair neatly pulled back. Boys: Shorts, t-shirt, socks, ballet/jazz shoes.
Hip Hop: Comfortable clothing, clean gym shoes with dark colored soles.
Tap: Comfortable clothing and tap shoes
Modern: Tight fitting dance clothes, bare feet, hair neatly pulled back

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