Clone of Class Enrollment Form

PLEASE BE ADVISED: THESE CLASSES ARE FOR DANCERS 10 AND UP, LEVELS INTERMEDIATE-ADVANCED
Dancer's Name*
Type N/A if older than 18
Email Address*
Address (City, State and Zip)*
Phone Number*
Cell Phone
Age*
Is dancer under 18?*

YesNo
How did you find out about our program?*

InstagramFacebookSearch EngineStudent/ Parent Referral

Guest InstructorsNon refundable/ Non transferableIf paying for multiple classes, don't forget to select your classes below.

$20.00 Class 1

Skills and Drills w/ IbnNon refundable/ Non transferableIf paying for multiple classes, don't forget to select your classes below.

$20.00

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Subtotal

$0.00

Tax

$0.00

Total

$0.00

Would you like your future monthly payments broken into 2 installments for an additional 7% installment fee?

YesNo
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that the activities held at The X-Perience Dance Company are physical in conduct and could potentially result injury. I am aware of the potential risk associated with dance. However, XDC will not be held accountable in the event of a dance/ acrobatic or any physical activity related injury. Upon enrollment, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Signature*

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Date

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Payment Methods

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Parent's Info Name