Beth Walsh Dance Centre Online Registration

Registration

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Welcome to Beth Walsh Dance Centre! We look forward to meeting your child's Dance needs. Please complete the following registration form. Any questions regarding class placement or tuition fees please contact Miss Beth at tinsleydance@aol.com for assistance. #keepondancin

* 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*

Additional Info

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

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

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Please click on the Search button below, then choose the class. Classes are grouped by Age and style... Preschool- Adult ... Competition Program offered in Pre-teen, Junior and Senior Class levels with consent of Miss Beth...email her at tinsleydance@aol.com for more information. Students may enroll in competition classes with Miss Beth's approval if they are at the appropriate skill level and are not interested in participating in competitions at this time.

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

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

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

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

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

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

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

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Lilabilty

I am voluntarily participating in activities at the Beth Walsh Dance Centre, and any virtual online classes held by Beth Walsh Dance Centre and Staff. I understand that there are risks associated with my or my child's participation in this activity, such as physical and or psychological injury, pain, illness, disfigurement, temporary or permanent disability, death or economic loss. These injuries or outcomes may arise from my own or other's actions, inactions, or negligence, or the condition of the BWDC location or facility. Nonetheless, I assume all risks of my or my child's participation in this activity, whether known or unknown to me.

I've read the above and agree.

Release

In consideration for being allowed to participate in activities at the Beth Walsh Dance Centre, I release from liability and waive my right to sue Beth Walsh Dance Centre, their employees, officers and volunteers from any and all claims, including claims of BWDC's negligence, resulting in any physical injury, illness(including death) or economic loss I may suffer or which may result from my participation in the activities at BWDC, including virtual online classes, travel to and from BWDC, (including air travel), or any events incidental to BWDC.

I've read the above and agree.

Payment Terms

CREDIT CARDS ON FILE WILL BE USED TO PAY TUITION 48 HOURS AFTER FIXED FEES ARE POSTED UNLESS OTHER ARRANGEMENTS ARE MADE AT TIME OF REGISTRATION PLEASE CHECK YOUR ACCOUNT 48 HOURS AFTER REGISTRATION FOR YOUR FIXED FEE AMOUNT

Late Fee (tuition after 15th month) = $15.00
NSF Fee (any returned check or bank Draft or declined Credit card) = $15.00
Refunds == There are NO refunds offered once the student begins the semester

Membership payment Plans:
*Monthly == by the 7th of each month (August-May) - only available for students who take 5 or more classes per week per Student in the 2018-2019 year
*Paid in full == for 2018-2019 classes only (September-June) payment Due by August 31st 2018 5% discount will be calculated by the office
*3 payment plan == Pay 2018-2019 in 3 payments (required for students taking 1-4 classes per week per Student) 1st payment due by August 7th 2018 , 2nd Payment due by December 7th 2018 and last payment due by March 7th 2019

If Monthly or 3 payment plan is chosen-- the office will manually adjust your fees to a student fix fee within 24-48 hours from the time of registration. Payment for the First payment is due once your monthly or 3 payment plan fee is calculated. Please check your account with in 48 as fee will be charged to your credit card on record...if you choose to pay with cash or check please set up payment arrangements with Miss Beth at tinsleydance@aol.com at time of registration

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

Membership Type*

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*