Dance Inc. Student Registration Form

Click HERE to see our current schedule of classes.

Click HERE to see our current hourly tuition rates.

Today's Date: *

Current Status: *

Returning Student

New Student

If you are a new, how did you hear about us?

Referred by:

Student's Last Name: *

Student's First Name: *

Birthday Mo/Day/Yr: *

Parent's Name: *

Phone Number: *

Emergency Phone Number and relation to student *

Address: *

City: *

State: *

Zip: *

Email Address: (VERY IMPORTANT) *

Class 1 #: *

Class 1 Subject: *

Class 1 Day: *

Class 1 Time: *

Class 1 Length: *

Class 2 #:

Class 2 Subject:

Class 2 Day:

Class 2 Time:

Class 2 Length:

Class 3 #:

Class 3 Subject:

Class 3 Day:

Class 3 Time:

Class 3 Length:

Class 4 #:

Class 4 Subject:

Class 4 Day:

Class 4 Time:

Class 4 Length:

Class 5 #:

Class 5 Subject:

Class 5 Day:

Class 5 Time:

Class 5 Length:

Total Hours Per Week: *

2024 SUMMER CAMPS & CLASSES:

Please select credit card option to register for Summer Camps & Classes.

You will be charged one time for camp/class enrollment.

You not be charged the annual registration fee listed below.

3% processing fee applies

2023-2024 DANCE SEASON TUITION PAYMENT OPTIONS:

I understand first month's tuition and reg. fee are due with registration. Payment accepted by cash, check or credit card. 3% credit card processing fee will be waived for first month's tuition and registration fee.
IMPORTANT - Please supply credit card information for first month's tuition and registration fee or contact the studio with payment. Non-refundable $40.00 registration fee and $25.00 per additional family member is due when registering.

Please select one of the following three options as your FUTURE monthly payment method. *

CHECKING ACCOUNT MONTHLY REOCCURRING PAYMENT Reoccurring tuition payments made using the “bill pay” feature of your bank’s online banking. Your bank will send us a check so that we can properly credit your account. Do not arrange for direct transfer of your tuition from your bank to our bank, or other person to person payment options - your account will not be properly credited. Tuition payments must be received by the first week of each month. Use the following information to set up payment: Dance Incorporated 15933 Manchester Rd. Ellisville, MO 63011 Phone 636-394-0023

BI-ANNUAL PAYMENT Tuition payments are made via cash, check or credit card twice per season. A 3% transaction fee will be added to credit card tuition transactions. Payments are due Sept. 1 and Jan. 15

CREDIT CARD MONTHLY AUTOMATIC PAYMENT Sept. through May. Tuition payments are automatically charged within the first week of every month. 3% Monthly fee will be added to these transactions

Payment:

Visa

Disc.

Card Number:

Expiration Date:

CVV#

Your signature here! (Use your mouse to sign in this box. If you need to start over click the "clear" link below.)

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NOTICES & TERMS:

FIRST MONTH'S TUITION PAYMENT AND REGISTRATION FEE

First month's tuition and reg. fee are due with registration. Payment accepted by cash, check or credit card. 3% credit card processing fee will be waived for first month's tuition and reg. fee.

Non-refundable $40.00 registration fee and $25.00 per additional family member is due when registering. Waived if registering for summer classes and camps

• Registrations accepted at the front desk, by phone, mail or online at www.dance-inc.com

• Tuition is based on the total hours per week. For the hourly tuition rates please refer to the tuition table page.

• Additional family members receive a 15% discount!

• Advise front desk of any changes in contact information

• All information pertinent to students is sent via email

• 2023-2024 DANCE SEASON Tuesday, September 5, 2023 through Saturday, May 25, 2024

• Notice of withdrawal from a class or withdrawing completely, must be in writing and given to the front desk. This ensures tuition charges are posted correctly on accounts

• 3% processing fee added to all credit card transactions excluding merchandise

I authorize Dance Incorporated’s faculty and staff to seek emergency medical help
for my child if necessary.

By registering, students agree to the release of their images/likenesses as they relate to Dance Inc./MPA. These will be used solely by Dance Inc./MPA for the promotion and marketing of dance programs and will not be sold.

I have read and agree to the above terms and conditions. *

I agree.