Dancercise Kids Registration

Child Care Center Name*
Choose the school your child attends
New Horizon Academy
Choose the specific New Horizon Academy your child attends
Class Day And Time
Class Day And Time
Child's Classroom Name (if known)
The room your child is in at the center
Child's Name*

First NameLast Name
Child's Gender*

BoyGirl
Child's Date Of Birth*

MonthDayYear
Date
Child's Age*
31 mos
Please check your child's date of birth (it's common to accidentally choose the wrong year!)
Add 2nd Child

I'd like to add a sibling to this registration
(2nd) Child's Classroom Name (if known)
The room your child is in at the center
(2nd) Child's Name

First NameLast Name
(2nd) Child's Gender

BoyGirl
(2nd) Child's Date Of Birth

MonthDayYear
Date
(2nd) Child's Age
31 mos 2nd
Please check your child's date of birth (it's common to accidentally choose the wrong year!)

Employee Of This Child Care Center

Employee
Job Title
Other Job Title
e.g. Director, Teacher
Promotional Code
In the event we need to make a schedule adjustment, we request your child’s typical school schedule so we can try to accommodate for your attendance
Attendance

Full-TimePart-Time
Days Usually Attending

MondayTuesdayWednesdayThursdayFriday
Child Usually Arrives At School

:HourMinutesAM/PM Option
Child Usually Leaves School

:HourMinutesAM/PM Option

Parent And Payment Information*

Credit Card Validation$1

Authorization only - no charge is made on your card.

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent E-mail*
Parent Phone*
Terms Of Participation

I acknowledge that Kids Fun Inc. DBA Dancercise Kids is a third party provider to child care centers that offers dance and fitness classes for children. While the Dancercise Kids teachers make every effort to ensure the children's safety, I will not hold Kids Fun Inc., its employees or any of its subsidiaries or affiliates liable in the highly unlikely event that my child should sustain an injury.

I agree that Kids Fun, Inc may charge my credit card on the 15th of each month for my membership and any balance due. No refunds will be given after my card is charged.

I understand that, to cancel my monthly membership, I must submit this form prior to the 15th of the month. No further charges will be made, my account will be closed, and I will receive an email confirmation.

I have read and agree to the terms and conditions, and privacy policy, of Kids Fun, Inc. as published on this website, and which may change without notice at any time.

I understand that Dancercise Kids classes are a parent-approved service that is not a part of the child care center program. I give Dancercise Kids teachers permission to check my child out of their classroom at their child care center while staying on the premises, to attend these dance and fitness classes. I understand the Dancercise Kids teacher will be responsible for my child’s care for the duration of class, and at the end of class, the Dancercise Kids teacher will also be responsible to check my child back into their classroom at their child care center.

By typing my full name below, I am signing this registration form electronically. I agree that my electronic signature is the legal equivalent of my manual signature.
Electronic signature of parent*

First NameLast Name
Signature Date*

MonthDayYear
Date
Should be Empty:

Terms Of Participation