NSAM Registration Form

Dancer No. 3

Information and Class Selection(s)
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Grade for the current/upcoming school year
Same mailing address as previous dancers?

Yes
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Cell (if applicable)
Student's Email (if applicable)
example@example.com
This year we are going to offer virtual options for our classes, please note your preference.

Live Classes (at the Studio)Virtual Classes (at home)
New or Returning Student?

Returning StudentNew Student
Contemporary Ballet

Beginning Youth (Ages 5-8) Meets 1x/week - Wed 4-5:00PIntermediate Youth (Ages 9-Beginning Teens/Adults) Meets 2x/week - Tues, Thurs 4-5:00PIntermediate/Advanced Teens - Adults (Ages 12+) Meets 3x/week - Mon, Wed, Thurs 5:15-6:30P
Dance Electives

Pointe (Teacher Placement Only) Meets 1x/week - Tuesdays 5:15-6:15P
Please indicate if the dancer has any medical conditions that the teachers and volunteers of NSAM should be aware of (i.e. severe allergies, asthma, injuries, current/previous injuries).
Is the Dancer Vaccinated for Covid-19?
As we prepare for dancers to return to the studio, this information allows for better class planning and performance opportunities.

Parent/Guardian Information

Please provide contact information for one or both parents/guardians.
Is the dancer over 18?

Yes, parent/guardian info is not applicable.No
Parent/Guardian Name #1

First NameLast Name
Phone Number
Does this number receive text messages?
Email (for dance related correspondence)
example@example.com
Parent/Guardian Name #2 (optional)

First NameLast Name
Phone Number
Email
example@example.com
Is the primary mailing address the same as "dancer 1"?

Yes
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (If Dancer/Parent/Guardian cannot be reached)
Phone Number
Relationship to Dancer(s)
Photography/Video Consent

Yes, I give consent to the use of photographs/video taken during the course of enrollment for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources).No, I do not give consent to the use of photographs/video taken during the course of enrollment for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources).
Are you interested in helping in any of the following areas?

FundraisingPromotionPerformancesGrant Writing
Other

Waiver of Liability | Pacific Dance Ensemble & NSAM

Assumption of Risk | Liability Release | Waiver/Release for Covid-19
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.

WAIVER/RELEASE FOR COVID-19

Newport School of Artistic Movement | Pacific Dance Ensemble ("NSAM | PDE") cannot prevent you or your child(ren) from becoming exposed to, contracting, or spreading COVID-19 while at NSAM | PDE's services or premises. It is not possible to prevent the presence of the disease. Therefore, if you choose to utilize NSAM | PDE's services and/or enter onto NSAM | PDE's premises, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

In consideration of being allowed to enroll and participate in NSAM | PDE's dance classes and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

Participation includes possible exposure to and illness from infectious diseases, including but not limited to influenza and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of illness does exist; and,

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation; and,

I willingly agree to comply with the stated and customary terms and conditions for participation regarding protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release and hold harmless NSAM | PDE, their officers, employees, and/or other participants, sponsors, advertisers used to provide dance classes and/or conduct events (“releases”), with respect to any and all illness disability, death, loss or damage to of property, whether arising from the negligence of releases or otherwise, to the fullest extent permitted by law. I agree to only send my dancer(s) to class without any symptoms of Covid or any virus, and that I will abide by all the rules and regulations implemented to protect all the students.
- I agree to only send my dancer(s) to class without any symptoms of Covid or any virus, and that I will abide by all the rules and regulations implemented to protect all the students.
- If a dancer comes down with COVID-19, everyone in the class will be required to bring proof of a negative test, in order to return to class.
- Any dancers who contract Covid-19 will be required to stay home for 10 days regardless of symptoms or vaccination status and must bring proof of a negative test before returning to class.
- Non-essential people (friends and parents) will not be allowed into the studio, at least through the end of 2021.
I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE.

By selecting "I Agree" and entering your name below you agree to and acknowledge the above and release NSAM | PDE 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. *
Name

First NameLast Name

Financial Policy

Tuition | Family Discount | Class Fees
Tuition Policies

Tuition is due on the 1st class of each month. A $10.00 late fee will apply to all accounts not paid in full by the 15th of each month. Any returned check will be subject to a $25 returned check fee. All payments remitted via credit card will be charged a 3% convenience fee.

NSAM does not pro-rate or refund tuition. Dancers may request permission to attend another class as make up for missed classes.

Financial aid is need-based and primarily awarded on a case-by-case basis and as available funds allow. Families seeking assistance should contact the director of NSAM, Nancy, for information and application. (541) 961-2316 PDEdance@msn.com

Family Discount

Families with two or more students enrolled in dance classes will receive 5% off their TOTAL dance tuition. For online payments, the discount will automatically be applied to the total.

Class Fees and Payments

The monthly tuition fees listed are per dancer, not per family. Dance electives and additional classes per week are optional, and their monthly fees are in addition to the contemporary ballet monthly tuition.

Contemporary Ballet (Core Dance Classes)

Beginning Youth - Meets 1x/week | $50
Intermediate Youth/Teen/Adult - Meets 2x/week | $95
Intermediate/Advanced Teen/Adult - Meets 3x/week | $135

Dance Electives (Optional)

Quick Picks (10-15 min) - Meets 2x/week | $30
Pointe - Meets 1x/week (Teacher placement/approval required) | $45

Additional Intermediate Class 1x/week | $50/month

Additional Intermediate/Adv. Class 1x/week | $60/month

Single Drop-In Class | $15/class

Monthly tuition payments can be made online via the NSAM website. You may also pay with cash or check by delivering/mailing payment to:

NSAM
454 SW 7th St.
Newport, OR 97365
Please make checks payable to NSAM

Checks and cash will be applied on the date they are received.

All checks and/or cash must be submitted in an envelope and clearly marked with the date, name of dancer(s), and class level.
Please select your method of payment for registration/first month's tuition*

Check /CashPayPal/Credit Card

Cash/Check Payment - Registration and First Month's Tuition

You may also pay with cash or check by delivering/mailing payment to:

NSAM
454 SW 7th St.
Newport, OR 97365
Please make checks payable to NSAM

Families with two or more students enrolled in dance classes will receive 5% off their TOTAL dance tuition.

Checks and cash will be applied on the date they are received.

All checks and/or cash must be submitted in an envelope and clearly marked with the date, name of dancer(s), and class level.

Please deliver or mail payment at your earliest convenience.

Thank you for your registration!

Online Payment and Registration Submission

All payments remitted via credit card will be charged a 3% convenience fee.

Please select the box for each class(s) selection and quantity/number of dancers registering for the class(s). Family discount and early registration information included below total.

Beginning YouthMonthly tuition fees per dancer.

$ Free Quantity of Beginning Youth Dancers
Item subtotal:$0.00

Intermediate YouthMonthly tuition fees per dancer.

$ Free Quantity of Intermediate Youth Dancers
Item subtotal:$0.00

Advanced Teen/AdultMonthly tuition fees per dancer.

$ Free Quantity of Advanced Teen/Adult Dancers
Item subtotal:$0.00

Dance Elective | Pointe (Teacher Approval Required)Monthly tuition fees per dancer.

$ Free Quantity of Dancers Electing Pointe
Item subtotal:$0.00

Dance Elective | Quick PicksMonthly tuition fees per dancer.

$30.00 Quantity of Dancers Electing Single Class
Item subtotal:$0.00

Additional Class (Intermediate) 1x/week Per month

$50.00 Quantity of Dancers Electing Single Class
Item subtotal:$0.00

Single Drop-In ClassPer drop-in class

$15.00 Quantity
Item subtotal:$0.00

Late Fee (after the 15th of each month)Please include a late fee if your monthly tuition payment is submitted after the 15th of the month.

$10.00

Enter coupon

Total

$0.00

Discount Code Information
- Enter LABORDAYPLUS for a 10% early registration discount before September 15
- A 5% family discount will automatically apply to the final total when registering multiple dancers in the same contemporary level.
- If the dancers are in DIFFERENT contemporary levels, use discount code 1PLUS1 when registering dancers (For example, 1 dancer is in beginning youth and 1 dancer is in intermediate youth).
If you "Pay with PayPal", your registration form is submitted with the payment. You do not need to return to the form to submit your registration.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Newport School of Artistic Movement

Dancer Information

Class Information

Contemporary Ballet (Core Dance Classes)

Dance Electives (Optional)

Additional Classes

This is for students enrolled in Intermediate or Intermediate/Adv. interested in additional classes each week)

Single Drop-In Class

Dancer No. 2

Dancer No. 3

Parent/Guardian Information

Waiver of Liability | Pacific Dance Ensemble & NSAM

LIABILITY RELEASE

WAIVER/RELEASE FOR COVID-19

Financial Policy

Tuition Policies

Family Discount

Class Fees and Payments

Online Payment and Registration Submission