4.1.3. Dance Academy 2021- 2022 Online Registration
Please use the below form to begin your registration for the 4.1.3. Dance Academy for 2021-2022.
Please understand that the classes you choose below may already be full. We will contact you with an invoice and your official classes within 48 business hours. I/we understand by submitting this registration form that I am aware and in agreement to all of 4.1.3. Dance Academy's policies and regulations.
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Email *
Student Name (LAST, FIRST) *
Parent(s) Name (LAST, FIRST) *
Student Age *
Student Date of Birth *
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Mailing Address *
Primary Phone Number *
How did you hear about 4.1.3. Dance Academy? *
Required
Name of Person Responsible For Payment *
ALL students must have a credit card on file. Please fill out your type of credit card, card number and expiration date. This information will NEVER be shared. *
I would prefer to pay my tuition by: *
Required
I would like to pay my first month/registration fee by: *
Required
I understand and agree to pay my first payment that includes a one-time registration fee ($50), pro-rated August tuition, and September tuition. This payment will be charged to the choice listed on the previous question. *
Required
Does your student have any medical conditions or allergies that we should be aware of? *
Medical Release: In the event you are unable to reach me, or in the case of accident or injury, I give my permission for treatment as deemed necessary by staff at 4.1.3. Dance Academy or emergency personnel. I also release 4.1.3. Dance Academy and its staff of liability in case of injury or accident incurred to my student. (Initial Below)                                                                                   *
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