CT Dance Conservatory Online Registration

Registration

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Welcome to CT Dance Conservatory! 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*

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

2020/2021 will be my ___ year*

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

2020/2021 will be my ___ year*

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

2020/2021 will be my ___ year*

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

2020/2021 will be my ___ year*

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

2020/2021 will be my ___ year*

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

On behalf of myself and my child, I hereby waive, do waive, release and hold harmless the Connecticut Dance Conservatory, it's representatives, successors, assigns, principles, employees, agents and the like, from any and all claims for damages including, but not limited to, any injuries suffered by myself and/or child in any program or facility offered by the Connecticut Dance Conservatory. In recognition of the inherent risks involved in this program, I hereby accept full responsibility for any injury or damages sustained by myself and/or child and will hold the Connecticut Dance Conservatory, it's representatives, successors, assigns, principles employees, agents and the like, harmless from any claim. The waiver and hold harmless is given consideration of the Connecticut Dance Conservatory accepting my child as a student and enrolling my child in its programs.

I've read the above and agree.

Payment Policy

Payment is due by the 15th of each month. If payment is not received by the 15th of the month the account is at risk of acquiring a $25 late fee. If a check is used as payment and is returned accounts will not only receive a late fee but will also acquire a $35 Return Check Fee.

If choosing to pay by Automatic Payment, card or check is kept on file to be used as payment. If payment is declined a late fee will be applied to the account, if check is returned a late fee and bank processing fee will be applied to the account.

By accepting this agreement, I acknowledge that these fees will be applied to my account if payment is late and/or if my payment in the form of a check is returned.
If tuition has gone unpaid, my dancer is subject to a suspension of classes until my account is made current and I have spoken to a front desk staff member regarding a payment plan.

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*