Season 18 Registration Process
One form per dancer
Family Last Name
*
Student Name
*
First Name
Last Name
Student's Birthdate
*
-
Month
-
Day
Year
Date
What school does your child attend?
N/A if they do not attend school
What grade will your child be attending in the fall?
*
Please Select
Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Guardian #1 Name
*
First Name
Last Name
Guardian #1 email
*
example@example.com
Guardian #1 address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian #1 Phone
*
Please enter a valid phone number.
Guardian #2
First Name
Last Name
Guardian #2 email
example@example.com
Guardian #2 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian #2 Phone
Please enter a valid phone number.
Emergency Contact (other than guardians listed above)
*
First Name
Last Name
Emergency Contact's relationship to dancer
*
(grandmother, aunt, etc.)
Emergency Contact's Phone number
*
Please enter a valid phone number.
How did you hear about us?
*
Friend
Internet, Social Media
Other
Please tell us your friend's name so we can properly than them!
*
Friend's Name
Internet:
*
Google search
Face Book
Instagram
Please let us know where you found us!
*
Class Selection
Choose your class:
My Products
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Membership Fee
This fee will cover your Membership Fee for the season!
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Mini Experience
This payment covers your First Installment. With this option, you will attend 2 classes per week for the duration of the 33 weeks. Please select your 2 classes in the next step. Your payment schedule you will see listed below!
$
142.00
Single Class A La Carte
This payment covers your First Installment. With this option, you will attend 1 class per week for the duration of the 33 weeks. Please select your 1 class in the next step. Your payment schedule you will see listed below!
$
76.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Payment Information
Reminder: if a credit card or debit card is used, a 3% convenience fee will be added to the charge. Even if you are planning on using cash, you will still be required to submit a card or account on file.
Select your payment method:
*
Checking Account
Credit Card or Debit Card (3% convenience fee will apply)
Cash
Checking Account - Routing Number
*
Checking Account - Account Number
*
Credit Card - Account Number
*
Credit Card - Expiration Date
*
mm/yyyy
Reminder: If you select to use a credit or debit card for the remainder of Season 18, a 3% convenience fee is added to each charge. If you are paying cash, it will be paid in 3 equal payments due as follows: August 25th (Sept-Nov), November 25th (Dec-Feb) and February 25th (Mar-May). Costume payments must be paid by October 1 and November 1 if you do not want your account on file run. Performance fee payment must be paid by February 1 if you do not want your account on file run.
*
I understand that if I select to pay cash during Season 18 after this initial payment, I will still need to keep a checking account or credit card on file. If payment is NOT made by the dates below, my account on file will be run. If my credit card/debit card is run, I understand that there will be a 3% convenience fee added. The payment schedule for cash for your tuition installments is: first payment and membership fee due upon registration; then 3 equal payments due as follows: August 25th (Sept-Nov), November 25th (Dec-Feb) and February 25th (Mar-May). Costume payments must be paid by October 1 and November 1 if you do not want your account on file run. Performance fee payment must be paid by February 1 if you do not want your account on file run. Please initial below.
*
I would like to keep:
*
a checking account on file.
a credit card on file.
Checking Account - Routing Number / Account number
*
############ / ###########
Credit Card - Account number and expiration date to keep on file. I understand that a 3% convenience fee will be added on if this method is used.
*
XXXX XXXX XXXX XXXX mm/yyy
Payment agreement: Any declined accounts (Checking Account, Debit Card or Credit Card) will be assessed a $25 fee. After 3 times, I understand that I will have to switch to cash and pay 3 months ahead or pay the remainder of the year in FULL. By signing below, I agree to the terms in this form and hereby authorize Dance It Up with Music, LLC to charge my account on file the installment amount on the 1st of every month and other associated fees beginning in June 2022 and completing the installment plan. I also authorize Dance It Up with Music, LLC to charge the costume and performance fee on the assigned dates provided in the Policy Waiver, online and in all registration materials. All charges will appear as Dance It Up with Music. I also agree to give the studio office one month's written notice from the 1st to discontinue these charges.
*
Clear
I understand the investment schedule above and agree to my account being charged on the listed dates. If I need to change my account information prior to that date, I will call the studio at 609-581-0808.
*
Clear
Submit
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