Season 16 Dance Class Registration Form

Season 16 Dance Class Registration

Schedule Subject To Change
Dancer Information
Name *

First Name Last Name
Birth Date

Month Day Year
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please Select One
Please Select *

Current Dance Sensations Student (No Reg. Fee) New Studio Enrollment ($25.00 Reg. Fee)
Please Select Dancer’s Age Group For Class *

D-I: 2-4yr D-II: 5-8yr D-III: 9-11yr D-IV: 12-14yr D-V: 15 & Older Adult Classes
Please Select Child's Gymnastic Level

Gym-I: 2-4yr Gym-II: 5-8yr Gym-III: 9yr & Up Gym-IV: All Ages with No Spot Backwalker Gym-V: All Ages with No Spot Backhandspring
Please Select Your D-I or Gym-I Classes

Mon 3:30 D-I Tap & Ballet Tue 3:30 Gym-I Wed 4:15 D-I Hip Hop Thur 3:30 D-I Hip Hop Thur 4:15 D-I Tap & Ballet Sat 10:30 Gym- I Sat 11:15 D-I Tap & Ballet Sat 12:00 D-I Hip Hop
Please Select Classes
Please Select Your D-II or Gym-II Classes

Mon 3:30 D-II/III Ballet&Hip Hop Tue 4:15 Gym-II/III Wed 3:30 Gym-II/III Thur 4:15 D-II/III Tap & Jazz Sat 10:30 Gym-II Sat 11:15 D-II Tap & Ballet Sat 12:00 D-II Hip Hop Tues 5:45 Boys Hip Hop and Tricks
Please Select Your D-III or Gym-III Classes

Mon 3:30 D-II/III Ballet & Hip-Hop Mon 4:15 D-III Hip Hop Mon 5:00 D-III Lyrical Mon 6:30 D-III & D-IV Musical Theater Tue 4:15 Gym-II/III Tue 5:45 Boys Hip Hop & Tricks Tue 6:30 D-III Tap & Jazz Tue 7:15 D-III Hip Hop Wed 3:30 Gym-II/III Thur 4:15 D-II & D-III Tap & Jazz Thur 5:00 D-III & Up Lyrical
Please Select Your D-IV, D-V, Gym-IV or Gym-V Classes

Mon 6:30 D-III & D-IV Musical Theatre Mon 7:15 D-IV/V Hip Hop Tue 5:00 Gym-IV Tue 5:45 Gym-V Tue 6:30 Boys Hip Hop & Tricks Wed 4:15 Gym-IV/V Wed 6:30 D-IV & D-V Lyrical & Contemporary Thur 5:00 D-III & Up Lyrical Thur 5:45 D-IV/V Tap & Jazz
Please Select Your Additional Company Classes (Please note that Ballet Classes are 1.5 hour each)

Mon 4:15 Co. Ballet A Mon 5:45 Co. Training A Mon 5:45 Co. Ballet B Mon 7:15 Co. Training B & C Mon 8:00 Stretch & Conditioning B Mon 8:00 Co. Ballet C Wed 6:30 Stretch & Conditioning C Wed 8:00 Stretch & Conditioning A Sat 12:45 Pre-Pointe/Pointe Sat 9:30 Company Lite
Please Select Your Adult Classes

Tie 9:30 Adult Only (18+) Jazz
Parent/Guardian Information
Name *

First Name Last Name
Home Number *

Area Code Phone Number
Cell Number *

Area Code Phone Number
E-mail *
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the child prescribed an inhaler? If yes, please explain any instructions. *
- As Parent and/or Guardian of the named child/dancer/student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Dance Sensations Dance Studio INC . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
I hereby give my approval for my child’s participation in any and all activities prepared by Dance Sensations Dance Studio INC. during their time at Dance Sensations Dance Studio INC. or on location with Dance Sensations Dance Studio INC.. In exchange for the acceptance of said child’s candidacy by Dance Sensations Dance Studio INC. ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Dance Sensations Dance Studio INC. . and all its respective officers, agents, teachers, counselors, assistants, staff and representatives from any and all liability for injuries and illness to said child arising out of traveling to, participating in, or returning from classes, rehearsals and performances.

In case of injury or illness to said child, I hereby waive all claims against Dance Sensations Dance Studio INC. including all coaches, staff, teachers, assistants, councelors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities, including dance and gymnastics. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death. There is a risk of becoming ill that is inherent in all group activites. Some of these illnesses include, but are not limited to, the contraction of Covid-19.
Payment Agreement

I, the parent or guardian of dancer named above understand that payments are due upon completion of this form and must be paid Via CASH, CREDIT/DEBIT CARD OR CHECK for registration to be complete. (CHECK PAYMENTS MAY BE MAILED TO 226 BILLIOU STREET, STATEN ISLAND, NY 10312 - PLEASE INCLUDE DANCERS FULL NAME)

I understand that if registration is not complete with payment I forfeit my child's spot.

I understand there is a 25.00 (amount with 3.9% non credit card discount) enrollment/registration fee in addition to tuition for all students who were not registered in the 2021-2022 dance season.

I agree to make any and all payments on time.

I agree that any and all payments are non-refundable.

I understand that there will be no refunds.

I understand that there is a discount of 3.9% for any payments NOT made by credit card

I understand that Dance Sensations is unable to accept payment via Venmo or Zelle

I understand there is a returned check fee for all bounced checks
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature *

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