2021 Registration NSAM

Newport School of Artistic Movement

Registration Form
Session IV starts 4/9/2021

Session 4 will be online via Zoom.

Once you have registered, please use the following link to make your monthly or full session payment:

Payment Form
Student Name*

First NameLast Name
Email
example@example.com
Date of Birth*

MonthDayYear
Age*
Would you like to register another dancer?

YesNo
Student Name*

First NameLast Name
Email
example@example.com
Date of Birth*

MonthDayYear
Age*
Would you like to register another dancer?

YesNo
Student Name*

First NameLast Name
Email
example@example.com
Date of Birth*

MonthDayYear
Age*
Would you like to register another dancer?

YesNo
Student Name*

First NameLast Name
Email
example@example.com
Date of Birth*

MonthDayYear
Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Session 4 (4/9/2021-5/27/2021) Although class levels are combined, all classes will be geared primarily towards the upper level students in each class grouping. View class descriptions here:

Level 1/2 - (ages 4-7) Wed. - 2:00-2:40pmLevel 3/4 - (ages 8-11) Tues/Thurs - 4:00-5:00Level 5/6 - (ages 12+) Mon/Wed/Thurs - 5:30-6:15Choreography/Composition (8+) - Friday - 4:00-4:30Sister Stretch/Covid Bubble Buddies (8+) - TBAPointe Strengthening (10+) - Tues. - 5:30-6:00Quick Picks (9+) - Mon/Tues - 5:00-5:15
Session 4 (4/9/21-5/27/21) Please select your level when we are able to move to on-site classes.

Level 1 (3-5 yrs)Level 2 (6-7 yrs)Level 3 (8-9 yrs)Level 4 (10+ yrs)Level 5 (12+ yrs)Level 6 (14+ yrs)Beginning Pointe (10+ yrs)Intermediate Pointe (instructor permission)Quick Picks - 10 minute intensive
Parent/Emergency contact 1*

First NameLast Name
Phone Number 1*

Area CodePhone Number
Email 1
example@example.com
Parent/Emergency contact 2

First NameLast Name
Phone Number 2

Area CodePhone Number
Email 2
example@example.com
Liability Release
In consideration of Newport School of Artistic Movement and Pacific Dance Ensemble, I agree to assume all risk of accident or injuries sustained from whatever cause, in connection therewith and release Newport School of Artistic Movement, Pacific Dance Ensemble and their officers, agents and employees from any and all liability for such accident or injury.
By clicking "agree" and entering your name below you acknowledge the above and release NSAM from any and all liability. This action must be taken by the parent/guardian of the child on this form, or yourself if you are over the age of 18.*

Agree
Your Name*

First NameLast Name
Payment

Class	Montly Rate	Full Session Rate
Level 1/2	$45	$85
Level 3/4	$85	$161
Level 5/6	$105	$199
Choreography/Composition	$30	$50
Sister Stretch	$30	$50
Pointe Strenghtening	$30	$50
Quick Picks $5/2 picks	$20	$40

Full session rates include a 5% discount

FAMILY RATES are available. NSAM family rate allows all family members are counted as 1 student taking multiple classes. Select the payment option at the end of the class selection section.

Tuition is due the 1st class of each month. There is a $10 late fee for payments after the 15th of each month. There is a $25 fee for all returned checks.

NSAM does not pro-rate of refund tuition. Make-up classes are available and is advised.

For more information and questions please email or call;

pdedance@msn.com / (541)961-2316
Checkout

Select your classes and payment option here
A 5% discount is applied to a full session payment.

FAMILY RATES - for family rates select the family rate options at the end of this section.
prevnext( X )
Level 1/2 $45.00
Ages 4-7 Wednesday 4:00-4:40

Payment Options

Level 3/4 - Full Session $85.00
Ages 8-11 Tues/Thurs 4:00-5:00

Payment Options

Level 5/6 - Full Session $105.00
Ages 12 and up Mon/Wed/Thurs 5:15-6:15

Payment Options

Choreography/Composition $30.00
Learning through improvisation and collaboration Fri. 4:00-4:40

Payment Options

Sister Stretch/Covid Bubble Buddies$30.00
Partner with a sibling or friend in your bubble/pod

Payment Options

Pointe Strengthening $30.00
Ages 10+ Tuesday 5:30-6:00

Payment Options

Quick Picks $5.00
10 minute intensive class $5 for 2 picks (only available in pairs) $20.00/month

Payment Options

Family Rate Level 1 thru 6 - MONTHLY OPTION$85.00
For families with multiple students, select the total number of regular level classes your dancers are taking each week. If you are also taking specialty classes, please select those below. THIS OPTION IS FOR PAYMENT OF ONE MONTH OF CLASSES.

Classes Per Week (Monthly Payment)

Family Rate Level 1 thru 6 - FULL SESSION$161.00
For families with multiple students, select the total number of regular level classes your dancers are taking each week. If you are also taking specialty classes, please select those below. THIS OPTION IS FOR PAYMENT OF THE FIRST FULL SESSION OF CLASSES and includes a 5% discount.

Classes Per Week (Monthly Payment)

Family Rate Specialty Classes - MONTHLY OPTION$30.00
For families with multiple students, select the total number of SPECIALTY CLASSES your dancers are taking each week. THIS OPTION IS FOR PAYMENT OF ONE MONTH OF CLASSES.

Quantity

Family Rate Specialty Classes - FULL SESSION$50.00
For families with multiple students, select the total number of SPECIALTY CLASSES your dancers are taking each week. THIS OPTION IS FOR PAYMENT OF THE FIRST FULL SESSION OF CLASSES and includes a discount.

Quantity

Total $0.00
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If paying with cash or check, you may deliver or mail payment to:

454 SW 7th St. Newport, OR 97365

Please make checks payable to: NSAM.

Checks and cash will be applied on date received. All checks and/or cash must be submitted in an envelope and clearly marked with students name, level and the date.
Should be Empty:

Newport School of Artistic Movement

Session IV starts 4/9/2021

Session 4 will be online via Zoom.

Liability Release

Payment

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