American Dance Studio Online Registration

Registration

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Welcome to American Dance Studio! If you are signing up for a TRIAL CLASS , please complete all of the below information, select the classes you would like to trial, and select the Submit Registration button at the bottom of the page.

* 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)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Student Tee shirt size*

Please click on the Search button below, then choose the class. For Trial Class Registration: After you've selected the class, please change the drop down to Yes for Trial Class registration.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Student Tee shirt size*

Please click on the Search button below, then choose the class. For Trial Class Registration: After you've selected the class, please change the drop down to Yes for Trial Class registration.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Student Tee shirt size*

Please click on the Search button below, then choose the class. For Trial Class Registration: After you've selected the class, please change the drop down to Yes for Trial Class registration.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Student Tee shirt size*

Please click on the Search button below, then choose the class. For Trial Class Registration: After you've selected the class, please change the drop down to Yes for Trial Class registration.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Student Tee shirt size*

Please click on the Search button below, then choose the class. For Trial Class Registration: After you've selected the class, please change the drop down to Yes for Trial Class registration.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Liability

I/ We realize that participation in dance classes and activities could involve some possible personal injury. Despite precautions, accidents and injuries may occur. By signing this release form, I/We (the dancer and parent/guardian) assume all risk related to the use of any and all spaces used by American Dance Studios. I/We agree to release and hold harmless American Dance Studios including its owners, teachers, dancers, staff members, and facilities used by both entities from any cause of action, claims, or demands now and in the future. I/We will not hold American Dance Studios liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes, Furthermore, I/We agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by American Dance Studios.

I've read the above and agree.

Medical

I grant permission to the staff of American Dance Studio to take first aid or emergency measures as judged necessary for the care and protection of my child while under the supervision of the studio. In case of medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the emergency deems it necessary. I understand that in some medical situations the staff will need to contact the emergency resource before the child's parent, physician and or other person acting on the parent's behalf. I also understand and agree that the child's parents or legal guardians shall be responsible for any expenses incurred

I've read the above and agree.

Recital

Recital Fee: Costume per class hour $65, 2 tickets $40, Dvd/Download $30, Costumed Photo Portrait package $30. Recital Cast t-shirt $15, Syllabus Exam and Trophy $25. (Unlimited Preschool combo classes will be charged for 2 costumes only) These fees will be divided into 5 payments and deducted from February 1 thru June 1st along with tuition.

I've read the above and agree.

Payment Terms

Tuition will be posted to your Family account on the 25th of each month for the next Months tuition Fees.

Tuition will be deducted automatically on the first of the month. We accept all credit/debit cards as well as ach checking account debits. This is an annual tuition broken down into monthly payments. Missed classes are the responsibility of the student. They must be made up by attending comparable classes or forfeit that unit of instruction.

A $15 late fee will be assessed and deducted automatically after the 7th of the month if funds are not available on the due date of the 1st.

Any checks/bank drafts or Declined credit Cards that are returned/declined will be charged a $35 fee.

There are no refunds If a student discontinues mid- year they must pay a registration fee to re-register.
Students may discontinue classes at any time with a 2 week notice.

All video or photographs taken at our studio or events may be used for advertising or literature. This includes but is not limited to the studio, recital, competitions, workshops, conventions, fundraisers and travel performances. No compensation will be allotted for the use of these photographs or video tapes

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number