Passion Dance Center Form 2021-2022
New student registration fee: $85
Returning student registration fee: $45


After filling out this registration form.
Pay your registartion fee here: http://passiondancecenter.com/programs---class-schedule--rent-pdc.html
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Student First Name *
Student Last Name *
Student Age *
Student Date of Birth *
MM
/
DD
/
YYYY
Parent First Name *
Parent Last Name *
Parent Email address *
Parent Cell phone *
Street address (If apt please list unit #) *
City *
State *
Zip code *
Social Media (I.e.. Instagram, Facebook, Twitter) *
Does the student have any ailments or underlying conditions that puts them at higher risk during the Covid-19 pandemic? *
School attending *
Grade level *
Any previous dance training if so what genres, where and how many years? *
Do you want to earn a 12 year degree in dance? Note: Ballet, Tap, Jazz classes are required for this degree program. *
Classes enrolled in? *
Required
How did you hear about us? *
Required
T-shirt size *
Shorts size *
Leotard size *
Tights size *
Emergency Contact Name *
Emergency Contact Phone number *
Emergency Contact Relationship *
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.
Doctor’s name *
Medical Emergency Hospital
In the event of an emergency my child is to be transported to the hospital below.
Hospital name *
Hospital number *
Does the student have the Covid vaccination? *
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.
Parent or guardian electronic signature here *
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. During Phase 1 & 2 all payments will be online only. Do you understand these payment & tuition terms? Must enter YES below.
Enter Yes below in agreeance to Payments and Tuition statement above. *
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