Passion Dance Center 2019-2020 Registration Form
Student Information
New or Returning Student *
Student First Name *
Your answer
Student Last Name *
Your answer
Age *
Your answer
Birth date *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Student Email Address *
Your answer
Social Media (i.e.. Instagram, Facebook, Twitter)
Your answer
Does the student have any ailments or restrictions? If yes, please explain.
Your answer
School Attending *
Your answer
Grade level *
Your answer
Tshirt Size *
Shorts Size *
Leotard Size *
Tights Size *
Any previous dance training? Yes or No *
Your answer
How many years has the student been dancing? *
Your answer
List Current or previous dance school(s) *
Your answer
Do you want to earn a 12 year degree in dance? YES OR NO? If yes, Note that ballet, tap and jazz are mandatory classes for degree candidates. *
Your answer
Which classes do you desire to take? *
Check all that apply
Required
How did you hear about us? *
Required
Parent Information
Parent or Guardian First Name *
Your answer
Parent or Guardian Last Name *
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
Parent or Guardian Email Address *
Your answer
Social Media (i.e.. Instagram, Facebook, Twitter)
Your answer
Parent or Guardian 2 First Name *
Your answer
Parent or Guardian 2 Last Name *
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
Emergency Information
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Emergency Contact Relationship *
Your answer
Medical Emergency Information
Medical Emergency Doctor *
The undersigned gives permission to Passion Dance Center, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health. I request that our doctor/physician entered below to be called.
Your answer
Medical Emergency Hospital *
In the event of an emergency my child is to be transported to the hospital below.
Your answer
Release of Liability
Release of Liability *
As the legal parent or guardian, I release and hold harmless Passion Dance Center LLC, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Passion Dance Center, its owners and operators or in route to or from any of said premises. Entering your name below means you agree to the Release of Liability terms.
Your answer
Payment & Tuition Terms
Payment and Tuition *
Tuition is due by the first of each month. If accounts are paid after the tenth of the month, there will be a $10.00 late fee applied to the account balance. There is a $35.00 returned check charge for any checks returned by the bank. We do not prorate months for missed days, holidays or school vacations. Payments are kept up via quickbooks. If you begin a payment on quickbooks you must end it there and pay the online fees. All other cash and checks are accepted at the studio. Paypal will be an online fee as well. Please review our studio policies and procedures. Do you understand these payment & tuition terms? Must enter YES below.
Your answer
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