Checkout - Chance 2 Dance

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Username *USERNAMES MUST BE ALL LOWERCASE WITH NO SPACES and NO SPECIAL CHARACTERS. Please do not use your email address as your username.

Email *

Password *

Contact 1

Name *

Email *

Street Address *

City *

State *

ZIP *

Primary Phone *

Work Phone

Other Phone

Contact 2

Name *

Email *

Street Address *

City *

State *

ZIP *

Primary Phone *

Work Phone

Other Phone

Student Information

Child 1

Years of Dance Experience

Gender

Grade Level

Date of Birth

Child 2

Years of Dance Experience

Gender

Grade Level

Date of Birth

Child 3

Years of Dance Experience

Gender

Grade Level

Date of Birth

Child 4

Years of Dance Experience

Gender

Grade Level

Date of Birth

Special NeedsIf multiple children are listed please indicate which child has the special needs.

Season Enrolling In *SummerSchool Year (Fall/Spring)BothIf multiple children are listed please specify what season each child is enrolling in.

Classes Enrolling InIf multiple children are listed please indicate which child has the special needs.

Waiver and Release of Liability

Waiver and Release of Liability *I, the person(s) listed above in consideration of those services rendered, use of facilities and equipment, and instruction from and by Chance 2 Dance, LLC hereby agree to the following: I wish to engage the services of Chance 2 Dance, LLC, its staff and its facilities for the purpose of dance and other instruction and training. I will conduct myself in a reasonably prudent and safe manner at all times while participating in dance instruction or otherwise on facility property or grounds. I acknowledge and fully understand that I will be engaging in physical activity exertion that might result in injury, disability or other harm to myself or to others. I acknowledge and understand that dance instruction, and the use of facilities and equipment involves risk of harm, injury, loss, or damage to myself and to others. Knowing the risks, I assume all such risks and accept personal responsibility for the damages following such injury, which I, or my guests or invitees, may suffer. Further I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time and assume such risks. I herby hold harmless and indemnify Chance 2 Dance, LLC for any and all loss, harm, damages, or injuries to my person or property, including, but not limited to, legal damages, compensatory damages, punitive damages, costs and expenses of litigation and attorney's fees. I HAVE READ AND UNDERSTAND THE ABOVE WARNING, WAIVER, AND RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW I have read the above and agree.

Signature

Date

Payment Policies

Payment Policies *Your commitment to Chance 2 Dance, LLC includes keeping your account balances current. I understand that registration fees, costume fees, recital fees and tuition are non-refundable. I understand that all classes must be paid for in advance. I also understand tuition is due by the first working day of each month and must be paid monthly by cash, check, online, or auto-draft. I understand that there are NO refunds for missed or dropped classes - tuition is based on enrollment, not attendance. I understand that a $15 late fee will be applied on the 10th of each month if tuition & fees are not paid. And I also understand that any not sufficient funds fees incurred from a returned check or declined auto-draft transaction will have to be paid in addition to tuition.

Signature

Date

Media Release

Media Release *Chance 2 Dance, LLC has my permission to use my or my child's photograph publicly to promote the dance studio. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. I have read the above and agree.

Signature

Date

Registration Fee

The Registration Fee is $20. Your credit/debit card will be charged upon submission of this form.

Credit / Debit Card *

Registration fee is $20. Your credit/debit card will be charged upon completion of this form.

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Contact 1

Contact 2

Student Information

Waiver and Release of Liability

Payment Policies

Media Release

Van Buren Location

Greenwood Location

Alma Location