Class Registration

Please complete the form below
Your information is kept strictly confidential
*Required field

Student Name

First Name

Last Name

Student Age

Parent Name

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (For emergencies only)

(###)

###

####

List years and style of prior dance education (or enter "none")

NEW STUDENTS ONLY

Please type all classes (completed with level) in which you are registering for, separated with a comma

ex: Tap 1, Hip Hop 1, Ballet 1

Payment Plan

Monthly (8 Payments)

Annual (10% Discount)

Required Consents - Sign Name in Textbox

-Payment is due at the 5th of each month. -Summer payment is due in full prior to the start of camp session. -Payment must be remitted in full by the 10th day of each month. A payment is considered late if received after the 10th day of the month, and a $10 late fee will apply. -All students must have a $0 balance by the 15th day of the month. A student will not be permitted in the classroom with an open balance after the 15th day of the month. -All online payments will include a 3.5% processing fee. Any check or cash payment will not include this fee. -The non-refundable fall class registration fee is $30 per family and is a separate payment from tuition. -Summer camp registration fee is a one-time, non-refundable $20 and is a separate payment from tuition. -All tuition payments are final and non-refundable. -There will be a $50 non-refundable costume deposit due with September's tuition payment. -Holiday months are not prorated. -Classroom behavior must remain respectful to teachers and students. Any bullying, picking on, or teasing will result in removal from class. -Thank you for your cooperation with our policies.

Liability Release - Sign Name in Textbox

I, the parent, guardian, or other authorized registrant, understand the classes and programs offered at Momentum Dance Center the registered child will participate in. I acknowledge that there is a risk of injury when receiving instruction and at such times when I and/or my child is not receiving instruction. In consideration of the location, facility, personnel, and equipment provided to me and/or my child, I forever release, discharge, and hold harmless Momentum Dance Center and any of its employees, representatives, and members from all liability or claim.

Media Release - Sign Name in Textbox

I, the parent, guardian, or other authorized registrant, grant permission to Momentum Dance Center to use photographs and/or videos of the registered child for use in media publications including, but not limited to, social media, email, website, and newsletters. I hereby waive any right to inspect or approve the photographs or videos.

Comments

Please be sure to press "submit" before paying the registration fee!