2020 bellAdance Customer Registration Form

Fall 2020 Registration Form

Please fill in the form below.
Today's Date *

Month Day Year
Date
New or Returning Student/Family *
Primary E-mail (Note: Email is our PRIMARY form of communication!) *
Email is our #1 form of communication, please let us know if you change yours throughout the year!
Update Contact/billing information (Address/Phone No/Emergency Contacts)? *
Contact and billing information:
Parent #1 Name *

First Name Last Name
Parent #1 Number *
Parent #2 Name

First Name Last Name
Parent #2 Number
Secondary E-mail
Email is our #1 form of communication, please include if you'd like a second email address to receive notices.
Address *

Street Address

Street Address Line 2

City State

Zip Code
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *
Number of Students Registering *
Students Full Name *

First Name Last Name
Students' Birthday *

Month Day Year
Date
Age *
Current Academic School (as of fall 2020) *
Allergies or Medical Conditions we should be aware of *
Years of Dance Training *
Where have you trained?
How did you hear about bellA dance? *
Please review the Fall 2020 Schedule and indicate below the class(es) you would like to register your student for. bellA dance teachers will review this form and your request and contact you regarding correct class placement prior to verifying your placement.
Student 1 Class Selection (Please select all classes you would like to register this student for. You can select multiple classes by holding down CONTROL while clicking the class. You will specify classes for other student below) *
Additional notes/requests regarding class selection
Total hours of class per week (hours/monthly tuition) Note: This is the price for 1 dancers-there is a discount for multiple family members *

45 minutes $41/mo 1 hour $54/mo 1 hour 15 minutes $64/mo 1 hour 30 minutes $77/mo 1 hour 45 minutes $88/mo 2 hours $97/mo 2 hours 15 minutes $107/mo 2 hours 30 minutes $118/mo 2 hours 45 minutes $122/mo 3 hours $130/mo 3 hours 15 minutes $136/mo 3 hours 30 minutes $142/mo 3 hours 45 minutes $148/mo 4 hours $151/mo 4 hours 15 minutes $155/mo 4 hours 30 minutes $158/mo 4 hours 45 minutes $167/mo 5 hours $168/mo 1 student unlimited $175/mo Pre Company 1 Pre Company 2 Jr Company Intermediate Company Sr Company Intermediate Company + Pointe Sr Company + Pointe
Total hours for student #1 *
Additional Students Full Name *

First Name Last Name
Additional Students' Birthday *

Month Day Year
Date
Age *
Additional Students' Current Academic School *
Allergies or Medical Conditions we should be aware of *
Years of Dance Training *
Where have you trained?
Student 2 Class Selection (Please select all classes you would like to register this student for. You can select multiple classes by holding down CONTROL while clicking the class) *
Additional notes regarding class selection
Total Number of weekly class hours for Additional Student *
Additional Students Full Name *

First Name Last Name
Additional Students' Birthday *

Month Day Year
Date
Age *
Additional Students' Current Academic School *
Allergies or Medical Conditions we should be aware of *
Years of Dance Training *
Where have you trained?
Student 3 Class Selection (Please select all classes you would like to register for. You can select multiple classes by holding down CONTROL while clicking the class) *
Additional notes regarding class selection
Total Number of weekly class hours for Additional Student *
Total number of combined class hours for all students *
Tuition Information/Policy Acknowledgement *
Withdrawal Policy/Acknowledgement *
Performance Agreement *
Class Etiquette/Dress Code Agreement *
COVID-19 Waiver *

ASSUMPTIONAND ACKNOWLEDGEMENT OF COVID-19RISK, WAIVER OF LIABILITY AND RELEASE OF CLAIMS In response to the COVID-19 pandemic, bellA dance has implemented a number of policies, procedures, mitigation efforts, and recommendations to protect our staff and dancers in alignment with public health recommendations. Please read the procedures here: http://www.bell-a-dance.com/covid-19-response.html. Federal, state and local authorities' understanding of COVID-19 and guidance thereto continues to evolve. We ask that you and your dancer agree to comply with our protocols, policies, and procedures in effect at the time, as well as any changes thereto, and to honestly answer all screening questions. Because of the nature ofCOVID-19, it is impossible to eliminate or fully control all risks associated with COVID-19. We are doing everything we can to ensure you will not be exposed to, or acquire COVID-19, but know there is a possibility. Acknowledgment: By signing below you acknowledge on behalf of you and your child (a) We have informed you of the risk of contracting COVID-19 and you voluntarily accept and assume this risk; (b) you understand our rules and isolation protocols, you have been informed of the protocols, have had an opportunity to ask questions and agree to comply with the protocols; and (c) you understand we reserve the right to change the screening and isolation protocols at any time without notice and you agree to comply with, and be bound by, the revised protocols in effect at the time. Waiver of Liability & Release of Claims: By signing below and with full awareness and appreciation of the risks involved, you and your child comply with our rules and agree to not hold liable Bell A Dance, LLC, including April Bell, teachers and staff, for any issues related to COVID-19. My signature below acknowledges I have read, understand and voluntarily agree to the Assumption and Acknowledgement of COVID-19 Risk, Waiver of Liability and Release of Claims above.
To download a full version of the bellA dance policy agreement, click below.
Date *

Month Day Year
Date
Printed Name *
Signature *

Clear

Payment: There is a non-refundable registration fee of $30.00 per student/$15.00 per additional student is due at the time of registration in order to hold the student's class spot. *

Single Student Registration Fee (Required) $ 30.00

Additional Student $ 15.00

Family Registration (3 or more) $ 60.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Shortly after registering, you will receive an email from bellA dance confirming your student's registration and class placement. This email will have your first month's tuition invoice attached. You will need to submit an electronic payment for this invoice and from that payment your account will be set up to autodraft your monthly tuition on the 1st of each month through June. The additional fees stated above for costumes and performance fee will also be charged to this card in November, March, and May unless told otherwise. Please check the box below stating that you understand this enrollment policy. *

I understand I will be enrolled in automatic monthly tuition payments
Should be Empty:

3 to 5 year old/Mon (1hr)/4:00pm/Ballet & Tap (In Person)
3 to 5 year old/Mon (1hr)/5:30pm/Ballet & Tap (In Person) *New class starting November*
3 to 5 year old/Tues&Thurs (1hr)/10am/Ballet,Tap,Creative Mov. (In Person)
3 to 5 year old/Wed (1hr)/1pm/Ballet & Tap (In Person)
3 to 5 year old/Fri (1hr)/6:15pm/Ballet & Tap (In Person)
3 to 5 year old/Sat (1hr)/9:45am/Ballet & Tap (In Person)
4 to 5 year old/Tues(1hr)/3:45pm/Ballet & Tap (In Person)
4 to 5 year old/Wed (1hr)/4:15pm/Ballet & Tap (In Person)(Class Full- Choose as a 2nd option to be put on waitlist)
4 to 5 year old/Sat (1hr)/11am/Ballet & Tap (In Person)
6 to 8 year old/Mon (1.5 hours)/Ballet,Tap,Jazz/4:00-5:30pm (Virtual)
6 to 8 year old/Tues (2 hours)/Ballet,Tap,Jazz/4:00 - 6:00pm (In Person)
6 to 8 year old)/Thurs (1.5 hours)/Ballet,Jazz,Tap/4:15-5:45pm (In Person)
6 to 8 year old/Fri (1.5 hours)/Tap,Ballet,Jazz/4:30-6:00pm (In Person)
6 to 8 year old/Sat (2 hours)/Ballet,Tap,Jazz/10:00am - 12:00pm (In Person)
6 to 9 year old/Mon (1 hr)/Hip Hop/4:30pm-5:30pm (In Person) (This class is currently full. If selected you will be placed on a waitlist)
6 to 9 year old/Wed (1 hr)/Hip Hop/5:00pm-6:00pm (In Person) *NEW class starting November*
8 to 10 year old/Fri/Ballet (45min)/4:15-5:00pm (In Person)
8 to 10 year old/Fri/Modern (30 min)/5:00-5:30pm (In Person)
8 to 10 year old/Fri/Jazz (30 min)/5:30-6:00pm (In Person)
8 to 10 year old/Fri/Tap (45 min)/6:00-6:45pm (In Person)
Pre Teen/Teen/Mon (45 min)/Ballet/6:45pm (In Person)
Pre Teen/Teen/Mon (45 min)/Tap/7:30pm (In Person)
Pre Teen/Teen/Mon (45 min)/Modern/8:15pm (In Person)
Pre Teen/Teen/Wed (45 min)/Hip Hop/7:00pm (In Person)
Pre Teen/Teen/Wed (45 min)/Jazz/7:45pm (In Person)
Pre-Company I (In Person)
Pre-Company II (In Person)
Junior Company (In Person)
Intermediate Company (In Person)
Senior Company (In Person)
Adult Tap

3 to 5 year old/Mon (1hr)/4:00pm/Ballet & Tap (In Person)
3 to 5 year old/Mon (1hr)/5:30pm/Ballet & Tap (In Person) *New class starting November*
3 to 5 year old/Tues&Thurs (1hr)/10am/Ballet,Tap,Creative Mov. (In Person)
3 to 5 year old/Wed (1hr)/1pm/Ballet & Tap (In Person)
3 to 5 year old/Fri (1hr)/6:15pm/Ballet & Tap (In Person)
3 to 5 year old/Sat (1hr)/9:45am/Ballet & Tap (In Person)
4 to 5 year old/Tues(1hr)/3:45pm/Ballet & Tap (In Person)
4 to 5 year old/Wed (1hr)/4:15pm/Ballet & Tap (In Person)(Class Full- Choose as a 2nd option to be put on waitlist)
4 to 5 year old/Sat (1hr)/11am/Ballet & Tap (In Person)
6 to 8 year old/Mon (1.5 hours)/Ballet,Tap,Jazz/4:00-5:30pm (Virtual)
6 to 8 year old/Tues (2 hours)/Ballet,Tap,Jazz/4:00 - 6:00pm (In Person)
6 to 8 year old)/Thurs (1.5 hours)/Ballet,Jazz,Tap/4:15-5:45pm (In Person)
6 to 8 year old/Fri (1.5 hours)/Tap,Ballet,Jazz/4:30-6:00pm (In Person)
6 to 8 year old/Sat (2 hours)/Ballet,Tap,Jazz/10:00am - 12:00pm (In Person)
6 to 9 year old/Mon (1 hr)/Hip Hop/4:30pm-5:30pm (In Person) (This class is currently full. If selected you will be placed on a waitlist)
6 to 9 year old/Wed (1 hr)/Hip Hop/5:00pm-6:00pm (In Person) *NEW class starting November*
8 to 10 year old/Fri/Ballet (45min)/4:15-5:00pm (In Person)
8 to 10 year old/Fri/Modern (30 min)/5:00-5:30pm (In Person)
8 to 10 year old/Fri/Jazz (30 min)/5:30-6:00pm (In Person)
8 to 10 year old/Fri/Tap (45 min)/6:00-6:45pm (In Person)
Pre Teen/Teen/Mon (45 min)/Ballet/6:45pm (In Person)
Pre Teen/Teen/Mon (45 min)/Tap/7:30pm (In Person)
Pre Teen/Teen/Mon (45 min)/Modern/8:15pm (In Person)
Pre Teen/Teen/Wed (45 min)/Hip Hop/7:00pm (In Person)
Pre Teen/Teen/Wed (45 min)/Jazz/7:45pm (In Person)
Pre-Company I (In Person)
Pre-Company II (In Person)
Junior Company (In Person)
Intermediate Company (In Person)
Senior Company (In Person)
Adult Tap

3 to 5 year old/Mon (1hr)/4:00pm/Ballet & Tap (In Person)
3 to 5 year old/Mon (1hr)/5:30pm/Ballet & Tap (In Person) *New class starting November*
3 to 5 year old/Tues&Thurs (1hr)/10am/Ballet,Tap,Creative Mov. (In Person)
3 to 5 year old/Wed (1hr)/1pm/Ballet & Tap (In Person)
3 to 5 year old/Fri (1hr)/6:15pm/Ballet & Tap (In Person)
3 to 5 year old/Sat (1hr)/9:45am/Ballet & Tap (In Person)
4 to 5 year old/Tues(1hr)/3:45pm/Ballet & Tap (In Person)
4 to 5 year old/Wed (1hr)/4:15pm/Ballet & Tap (In Person)(Class Full- Choose as a 2nd option to be put on waitlist)
4 to 5 year old/Sat (1hr)/11am/Ballet & Tap (In Person)
6 to 8 year old/Mon (1.5 hours)/Ballet,Tap,Jazz/4:00-5:30pm (Virtual)
6 to 8 year old/Tues (2 hours)/Ballet,Tap,Jazz/4:00 - 6:00pm (In Person)
6 to 8 year old)/Thurs (1.5 hours)/Ballet,Jazz,Tap/4:15-5:45pm (In Person)
6 to 8 year old/Fri (1.5 hours)/Tap,Ballet,Jazz/4:30-6:00pm (In Person)
6 to 8 year old/Sat (2 hours)/Ballet,Tap,Jazz/10:00am - 12:00pm (In Person)
6 to 9 year old/Mon (1 hr)/Hip Hop/4:30pm-5:30pm (In Person) (This class is currently full. If selected you will be placed on a waitlist)
6 to 9 year old/Wed (1 hr)/Hip Hop/5:00pm-6:00pm (In Person) *NEW class starting November*
8 to 10 year old/Fri/Ballet (45min)/4:15-5:00pm (In Person)
8 to 10 year old/Fri/Modern (30 min)/5:00-5:30pm (In Person)
8 to 10 year old/Fri/Jazz (30 min)/5:30-6:00pm (In Person)
8 to 10 year old/Fri/Tap (45 min)/6:00-6:45pm (In Person)
Pre Teen/Teen/Mon (45 min)/Ballet/6:45pm (In Person)
Pre Teen/Teen/Mon (45 min)/Tap/7:30pm (In Person)
Pre Teen/Teen/Mon (45 min)/Modern/8:15pm (In Person)
Pre Teen/Teen/Wed (45 min)/Hip Hop/7:00pm (In Person)
Pre Teen/Teen/Wed (45 min)/Jazz/7:45pm (In Person)
Pre-Company I (In Person)
Pre-Company II (In Person)
Junior Company (In Person)
Intermediate Company (In Person)
Senior Company (In Person)
Adult Tap

Fall 2020 Registration Form

Contact and billing information: