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Referral Name
Family Last Name*
Home Address*
City*
State* AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNENCNDNHNJNMNYNVOHOKORPARISCSDTNTXUTVAVTWAWIWVWYPRVI
Zip*
Home or Primary Phone* [intl_tel* Home_Primary_Phone]
Emergency Contact Info*
Contact #1 First Name*
Last Name*
Type*
Home Phone*
Work #
Cell #
Email* (Emails are kept confidential)
Confirm Email*
Contact #2 First Name*
Home Phone
Email (Emails are kept confidential)
Confirm Email
Student's First Name*
Student Gender* FemaleMale
Birth Date* (format=mm/dd/yyyy)
Disabilites*
Special Needs*
Allergies
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SELECT CLASS* Wiggles & JammersDancin DivasElite Dancers
Assumption of Risk
I hereby release DANCE TO LIVE, LIVE TO DANCE (DTL) its agents and employees from all liability for personal injury, illness, property damage occurring on or off premises. I certify that my child is in good health and is capable of participating in all DTL activities.
I've read the above and agree.
Discount Policy
Family discounts The 1st child is full rate, the 2nd child - 10% discount, and the 3rd child - 15% discount. Discounts are given to immediate family only. Only one discount may be applied at any time. Any other promotional offers can not be combined. $25 will charged to any past due account. This includes accounts that cannot be processed due to inaccurate account information or expired cards. A $25 fee applied for any returned checks.
Payment Policies
Registration: A non-refundable fee of $10 per student or $15 per family is required at time of registration. 2016-2017 Tuition options: DANCE TO LIVE, LIVE TO DANCE offers 2 options: Per Semester and Monthly Payment Plan. If you register after the classes have begun, the first month (sessions) will be prorated. If you choose Monthly Payment Plan you must provide a credit card or debit card on file. On the first week of every month, your Credit Card will be charged the monthly tuition rate.
-Summer 5 Week Semester: WIGGLERS & JAMMERS- $195 (1 day a week) July 31 - August 28th, 2017 DANCIN' DIVAS- $250 (1 day a week) August 2nd - August 30th, 2017 ELITE DANCERS- $300 (2 days a week) August 2nd - August 31st, 2017
- Monthly Payment. Release forms are needed stating that we have permission to automatically debit your checking or savings account or charge your credit card for tuition on the 1st of every month. One month advance notice for withdrawal from class is required, and withdrawal form must be filled out in person at the front desk. Tuition remains the same whether it is a long (5 lessons) month or a short (3 lessons) month and regardless of absences. Payments by cash or check are accepted for a full Semester.
Medical Emergencies
I give permission to DANCE TO LIVE, LIVE TO DANCE (DTL) and/or appropriate medical facility to take whatever emergency (first aid, disaster evacuation, etc.) measures are judged necessary for the care and protection of my child. In case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency resources, (police, rescue squad) deems it necessary. The child will be transported at my expense. It is understood that in some medical situations, the staff will need to contact the local emergency resource before the parent, child's physician, and/or other adult acting on the parent's behalf. Further, I hereby release and agree to hold harmless and indemnify Rhythm &Beyond employees from any claims, losses, or expenses incurred on behalf of me, my child or my child's family.
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