Amanda's Dance Center Online Registration

* 1.

Select the Studio Location.

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* 2. How did you hear about Amanda's Dance Center?

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If you answered "other" or were "referred," please specify
* 3.

Child's Last Name


* 4.

Child's First Name


* 5.

Date of Birth


* 6.

Grade

What grade will your child be going into after the summer?

7. Full Names of additional siblings registering for Dance Class (leave blank if you are registering only 1 child)

8. Dates of Birth for additional siblings
9. Grade level of additional siblings registering for dance classes (ENTER 3YR. OLD, Pre-K, Kindergarden, 1st, 2nd, etc)
* 10.

Parent/Guardian Legal Name/Names


11.

Address

* Address Line 1

Adddress Line 2 (if needed)

* 12.

City


* 13.

Zip Code


* 14.

Phone #


* 15.

Email Address


16.

Emergency or Cell Phone Numbers

* 1

2

17.

Second Parent/Guardian Information (if applicable and different than above)

Name

Address

City

Zip Code

Phone #1

Work or Cell Phone #

18.

The following adults have permission to pick up my child from class:

1

Relationship

2

Relationship

3

Relationship

* 19.

My child's tights size is:

20. Additional Sibling Tight Size
21.

PLEASE LIST ANY MEDICAL OR HEALTH ISSUE THAT MAY AFFECT YOUR CHILD’S
PARTICIPATION IN OUR DANCE CLASSES. BE SURE TO LIST ANY FOOD ALERGIES.


* 22.

TERMS OF AGREEMENT

I, as parent or guardian of the above named student, have received the Parent/Student handbook or reviewed it online, and understand the policies of the studio. I agree that it is my responsibility to comply and have my child comply with these guidelines.

Studio Guidelines

  • Students should arrive 5-10 minutes before class time with hair neatly pulled back off of face & neck.
  • The Staff does not provide extended supervision for children, therefore, students who are enrolled in classes must be supervised by a guardian outside of class time.
  • Choreography decisions are at the sole discretion of the teacher. The staff reserves the right to alter staging at any time.
  • The final rehearsals in the auditorium are mandatory. Any student that does not attend these rehearsals, will not be permitted to perform in the production.
  • Refunds:No refunds, credits, or make-ups will be offered for missed classes. Please notify us if your child is sick and will be absent that day.
  • It is the responsibility of a parent or guardian to receive updates, notices, and schedule changes when their child is absent.
  • Code of Conduct: Students will be expected to pay attention and follow requests of staff and directors at all times; display the highest standards of respect for self and others; remain with staff members/volunteers at all times; and to be aware of conversation topics around younger dancers.
  • Amanda's Dance Center has the right to remove any student from the program without refund, for violation of rules or excessive absences.
  • Cell phones must be turned OFF at all times during classes.
  • No MP3’s or portable gaming devices permitted.
  • Dress: Students must wear appropriate dance attire and shoes. Please see the "Dress Code" page in the Handbook.
  • Observation: To keep distractions to a minimum, class time and rehearsals are closed. There are two Parent Watch Weeks during the year, when parents will be invited in to observe classes.
  • Those with unpaid balances will not be permitted to purchase tickets or receive costumes and their child/children will not be permitted  to perform in the recital.

I have read and understand the terms of agreement.

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23.

By entering my name, and the date; my child/children and I agree to the terms of agreement.

* Parent/Guardian

* Date

24.

MEDICAL CONSENT RELEASE

As parent or guardian of the above-mentioned child, I do hearby authorize the treatment of this child, by a qualified and licensed medical doctor or E.M.T. in the event of a medical emergency which, in the opinion of the attending medical personnel, may endanger the child's life, cause disfigurement, physical impairment, or undue discomfort, if delayed. This authority is granted only after a reasonable effort has been made to reach me. I hereby release, waive, discharge and covenant not to sue Still Smiling, LLC DBA Amanda's Dance Center, its directors, officers, agents, partners, (The Sunshine Park Mall, and Volusia County Schools), and employees for all the purpose written herein referred as “releases’, for all liability the above named student for any and all loss, injury, damage and any actions, claims, damages, costs, or expenses therefore which may arise out of or are in any way connected with the Amanda's Dance Center.

By electronically entering my initials and the date, I agree to the statements above.

* Parent/Guardian Initals

* Date

25.

PHOTO/DIGITAL IMAGE RELEASE

I give permission for my child/children to be photographed and/or videotaped, without compensation, and to have those pictures appear in any media coverage, and by any electronic means or media, for the purposes of promotion and advertising for Amanda's Dance Center.

By electronically entering my initials and the date, I agree to the statement above.

* Parent/Guardian Initials

* Date

26.

EMERGENCY INFORMATION

In case of an emergency, I should contact the following:

* FIRST CONTACT

* PHONE #

* SECONDARY CONTACT

* PHONE #

* DOCTOR'S NAME

* DOCTOR'S PHONE #

27.

AFTER THE SUBMISSION OF THIS FORM, YOU CAN FOLLOW THE LINKS ON THIS PAGE TO SECURELY PAY BY CREDIT CARD, OR SEND PAYMENT BY MAIL.  YOUR CHILD IS NOT REGISTERED UNTIL PAYMENT IS RECEIVED.