BCD Fall Registration Form

Student Information

A registration fee is required to secure a place for your child. Should the schedule not work for you, a full refund of the registration fee will be issued, provided we receive written notice via email no later than August 15th. Please note that children must be at least 2 years of age by September 1st to enroll in Story Time, and at least 4 years of age by September 1st to enroll in the Pre-Ballet class.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Gender
Birth Date
Parent Valid Email
School/Grade Level
Primary Doctor

First NameLast Name
Doctor Phone

Area CodePhone Number
Disabilities, Allergies, Medications
Previous Dance Experience
Family Information
Main Contact Person

First NameLast Name
Relationship to child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Secondary Contact Person

First NameLast Name
Relationship to child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
How did you hear about us?

Liability & Policy Agreement Form
Liability Waiver and Release of Claims
I, the undersigned participant and/or parent or legal guardian, hereby acknowledge and agree that participation in dance classes, rehearsals, and related activities involves inherent risks, including but not limited to physical injury, illness, and property damage.

To the fullest extent permitted by law, I hereby waive, release, discharge, and hold harmless Berkeley Center for Dance, LLC, its owners, employees, instructors, agents, and affiliates from any and all claims, liabilities, demands, or causes of action arising out of or related to participation in any program, class, rehearsal, or event, whether caused by negligence or otherwise.
☐ I acknowledge and agree
Medical Authorization
I authorize Berkeley Center for Dance, LLC to administer or obtain emergency first aid and medical treatment for the participant if deemed necessary. I further authorize transportation to a medical facility in the event of an emergency.

I understand that I am solely responsible for all medical expenses incurred.
I acknowledge and agree
Media Release
I grant Berkeley Center for Dance, LLC permission to photograph and/or record the participant during classes, rehearsals, and events. I further authorize the use of such images or recordings in promotional materials, advertisements, social media, and publications without compensation or further notice.
I acknowledge and agree
Payment Terms and Financial Agreement
I agree to the following financial terms:

Tuition is due in full on the 1st of each month.
Split or partial payments are not permitted.
A valid credit/debit card must be maintained on file at all times.
The card on file will only be charged if payment is not received by the next billing due date.
If the card is charged, applicable late fees and processing fees will be applied.
Late fees are assessed as follows: $10 after the 10th, $20 after the 20th, and $30 after the 30th of the month.
Accounts delinquent over 60 days may result in suspension from classes.
Returned payments will incur a $25 fee.
Tuition and costume fees are non-refundable and non-transferable.
Full account balance must be paid to receive costumes and participate in recital.
A $60 per class drop fee applies to any class dropped between December 1 and January 1.
After January 1, the account holder is financially responsible for the full remaining annual tuition, as well as all applicable costume fees.
I acknowledge and agree
Acknowledgment and Agreement
By signing below, I confirm that I have read, understood, and voluntarily agree to all policies, terms, and conditions set forth in this agreement. I acknowledge that this document constitutes a binding agreement between myself and Berkeley Center for Dance, LLC.
Parent/Guardian Signature:

My Products

Registration Fee$40.00

We require a nonrefundable registration fee to reserve your child’s spot in class. Once paid, this fee will be applied toward your child’s costume deposit. If the class schedule does not work for your family, we will refund the registration fee provided you notify us by email no later than August 15 at berkeleycenterfordance@gmail.com.

Total $0.00

Credit Card

Should be Empty:

Student Information

Family Information

Liability & Policy Agreement Form

Credit Card