Steps 'N Motion Dance Studio

Steps 'N Motion Dance Studio 2008-09 Registration

Family  Registration
 
A $65.00 non-refundable registration fee is required to register online using this form.
Solution Graphics
Please complete all information using your TAB key to move through the form.  Do NOT use the ENTER key to move through the form.  There is room for information for three family members.  If you are only registering two family members, leave the "Information for Student #3" section blank.  If you have more than 3 family members to register, please call the studio at 704-845-1180 to register by phone.  Click on the SUBMIT button to submit the form and proceed to the payment page.
 All fields are required for each family member you register.
Please choose one:  
Returning Family  
New Family  
Parent(s) Name:  
Street Address:  
City: State: Zip:
Home Phone: Cell Phone:
E-mail:  
Information for Student #1        
Studio Choice:(Please select one)        
The Fountains        
Wesley Chapel        
Student's Name:    
Birth date: (mm/dd/yyyy) Age:  
Please provide your class / day / time preferences and any comments.
   
Information for Student #2
Studio Choice:  (Please select one)        
The Fountains        
Wesley Chapel        
Student's Name:    
Birth date: (mm/dd/yyyy) Age:  
Please provide your class / day / time preferences and any comments.
   
Information for Student #3        
Studio Choice:  (Please select one)        
The Fountains        
Wesley Chapel        
Student's Name:    
Birth date: (mm/dd/yyyy) Age:  
Please provide your class / day / time preferences and any comments.
   

Notice:  Steps ‘N Motion Studio, Inc. and its agents urges for all students to obtain a physical examination from their physician prior to attending any class.

I have full knowledge that by nature class participation can frequently include exercise and body contact along with associated dangers.

In recognition of the possible dangers connected with any physical activity, students hereby knowingly and voluntarily waive any right of cause of action of any kind whatsoever arising as a result of such activity from which any liability may or could occur to Steps ‘N Motion Studio, Inc., Sabrina LeClair, its officers, agents, or employees or instructors.

I agree to waive claims against any person or organization connected with Steps ‘N Motion Studio. Inc. for any injuries I may sustain and likewise assume full responsibility for all my actions in connection with any classes.

Please type your name in the box provided below indicating you have read and understand the above notice.  Submitting this form indicates your understanding and agreement with the Hold Harmless notice provided above.
Signature of Parent (if participant is under 18):
Click SUBMIT to proceed to payment page (using Paypal or your credit card)