Umoja Dance Registration Form

Registration Form

Student Name *

Parent Name *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Email *

Email address that will receive class links, studio updates general information ***

Age *

Date of Birth *

Gender *

Allergies *

If none, write N/A.

Physical Restrictions *

If none, write N/A.

Emergency Contact *

Class Selection *

MONTHLY FEE
30min/45min/60min (Same Price)
1 Class per Month: $50.00
2 Classes per Month: $95.00
3 Classes per Month: $145.00
Students interested in Capoeira classes please contact ContraMestra Amazonas: mailto:amazonas.jb@gmail.com for prices.
All classes are taught via Zoom. Class link to join class will be sent the day before class.

Total # of Classes Per Month *

1 Class Per Month - $50.00 2 Classes Per Month - $95.00 3 Classes Per Month - $145.00

Total Due Today / Now

# of Classes Per Month plus $25 Non-Refundable Registration Fee

Please Select your Payment Type *

Registration Fee (Non-Refundable): $25.00

WAIVER / RELEASE

The participant agrees and understands that Umoja Dance Company carries insurance covering its legal liability. The participant accepts all risks of participating in a dance class. The participant will not make a claim against or sue the Umoja Dance Company or any of its officers or employees for injury or damage resulting from participation in the class. It is mutually agreed upon that the participant is considered to be in good condition to participate in the class.
The participant gives full permission for Umoja Dance Studio to use pictures or video from class and/or performances for advertising purposes. The participant understands that his/her name will not be used.
The participant has read the " Welcome Letter” and "Online Class Etiquette Letter" which includes Studio Policies and Student/Parent Rules. The participant will adhere to the rules otherwise will face dismissal from the studio.
The participant understands: NO REFUNDS and NO EXCHANGES.
The participant understands REGISTRATION FEES are due at the time this form is completed.
The participant has read the Tuition Rates & Payment Information sheet and agrees to comply with its policies. The participant understands that tuition is due on the first class of every month and that a $20 late Fee will be applied to any delinquent payments.
Tuition is required every month regardless of attendance.
Monthly tuition may not be skipped because of non -attendance. NO EXCEPTION.

Parent/Participant Signature

Clear

Date