Summer 2019 Registration Form

Register for summer programs here!

To register online, please fill this form out completely. Your credit card will not be charged until you hit the “Submit Registration” button on the last screen.

If you've registered previously and would like to use your same information, enter your email address here:

DANCER’S INFO
Dancer’s Name	First: Last:
If Musician, Instrument of Choice
Grade Entering Sept. ’24
Date of Birth	/ /
Address (incl. apt. #)
City	State Zip
Family E-mail address
PARENTS’ INFO
Required if dancer is under 18 and/or still living at home.
Parent 1 Name	First: Last:
Parent 1 Phone Numbers	Home: Work: Cell:
Parent 2 Name	First: Last:
Parent 2 Phone Numbers	Home: Work: Cell:
EMERGENCY INFO
This information is used in the event that we CANNOT reach a parent.
Emergency Contact Name	First: Last:
Emergency Contact Phone
Relationship to Dancer
Doctor’s Name	First: Last:
Doctor’s Phone

We encourage everyone to use our new ACH option! WHY ACH?

It’s convenient. Automation saves everyone time!
It’s dependable. Your payment is punctual (even if you’re out of town), eliminating potential late charges.
It’s more secure. ACH is federally regulated. Unlike credit cards, ACH accounts are rarely compromised.
SAVES YOU $$!! ACH provides administrative efficiency to keep your overall fees as low as possible.
Authorizing your initial Session Payment, and scheduling recurring payments if you wish, is a breeze!

Your ACH Authorization

You will be charged for your dancer’s Summer Registration and/or Personalized Plan via ACH per amounts indicated on your dancer’s registration form and/or Personalized Plan Lesson Fees Table only. Your payment will appear on your bank’s statement as an “ACH Debit.” (For easy accounting on your end, we include a memo note clarifying payment application). Most of your banks will notify you via e-mail at time of transaction (if you set up notifications with them). You agree that no prior notification will be provided by us unless the date or amount changes.

Admin Fee

Please keep in mind, our entire reason for switching to ACH payment processing is to AVOID raising your fees! IF you are unable to provide an ACH Authorization, the cost of that loss in efficiency will be applied to your dancer’s account $15/per payment transaction. This fee will be due and payable with your Summer Registration and/or Personalized Plan Deposit and, separately, for any account balance payments due.

Payment Type

Card Number

Name on Card

Expiration Date

I, authorize A Dancer’s Dream, Inc. to charge my bank account indicated below and as follows:

Summer Dance Dayz Payment Authorization. I understand I am authorizing immediate payment of my dancer’s Summer Programming as indicated on this completed Registration Form.
Summer PERSONALIZED PLAN Deposit and Balance. I understand that, if I am signing up for a Performance Team, I am authorizing immediate payment of the required $575 Personalized Plan Deposit Fee. I further authorize a separate payment of the remaining balance due in full upon confirmation of Personalized Plan schedule and prior to my dancer’s first summer lesson. Download the Personalized Plan Request Form, fill it out, and mail to us by May 1.
Further, I understand that I may authorize additional fees (added lessons, reps, etc.) be charged per my my specific written, e-mail, or text request. I further understand and authorize any and all outstanding fees due on my dancer’s account over 15 days past the due date be charged via this ACH process.
I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify A Dancer’s Dream, Inc. in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed on the next business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that A Dancer’s Dream, Inc. may at its discretion attempt to process the charge again within 30 days, and agree to an additional $35.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.

I agree to the terms above.

Billing address:

City:

State: Zip:

Phone:

Email:

Account Type:

Checking Savings

Name on Account:

Bank Name:

Account No.:

Bank Routing No.:

Bank City/State:

Show Participation, Workshops, Master Classes, and Summer Programming are NON-Refundable. Credits can NOT be issued for registered students who may miss their event.

Summer programs are non-refundable.

I, on behalf of the parties hereby registered, authorize A Dancer's Dream, Inc. & TAGteach International, LLC the use of the registered party’s image for educational and promotional purposes. Further, A Dancer’s Dream, Inc., TAGteach International, LLC, their associates & assigns are not liable for personal injuries, loss of or damage to personal property. Since dance is a physical activity, injuries may occur. Each student may decline to participate in any activity which may be harmful & is responsible to inform the instructor, in writing, of any physical limitations which may prevent full participation in class or any associated event.

By checking this box, I release all liability and compensation as stated above.

Summer 2019 Registration Form

VACATION FUN CENTER (Consider combining VFC days within the same week and $AVE!)

SPECIAL EVENTS

Your ACH Authorization

Admin Fee