Dance Quest International

Parent/Guardian Information

Parent/Guardian Name

First NameLast Name

E-mail

Phone Number 1

Area CodePhone Number

Phone Number 2

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact

First NameLast Name

Emergency Contact Phone 1

Area CodePhone Number

Emergency Contact Phone 2

Area CodePhone Number

Participant Information

Participant Full Name

First NameLast Name

Gender

Participant Birthday

MonthDayYear

Age

School Teachers Name

Is there anything we should know about the participant? Special Needs? Food Allergies? Medical Conditions? If so, please give us a brief explanation.

Location and Class Selection

We reserve the right to close any class if a class minimum is not reached. YOU WILL BE CONTACTED SHOULD THIS OCCUR WITH THE CLASS(ES) YOU HAVE SELECTED.

CBCS

Creative World (Causeway)

Dance Quest Studio (Parsons Ave)

Discovery Point (Summerfield Crossing)

Discovery Point (Symmes Rd.)

First United Methodist of Brandon

Horizon Early Learning Preschool

Immanuel Lutheran School

Nativity Catholic School

The Peacock's Plume

Stowers Elementary School

The Villages

Please read waiver carefully. Signed waiver is required before attending any classes.

FOR PARENT/GUARDIAN (of participant under 18 years of age) or participating student (over 18):

I hereby voluntarily enroll for dance courses, camps, workshops and related activities (rehearsals, performances inclusive) sponsored by DANCE QUEST INTERNATIONAL, INC.

By enrolling, I hereby agree to participate in these activities with the full knowledge that they involve physical stamina, aerobic activity and other unusual physical demands on the body, and that the risk of physical injury is inherent in any participation in dance and related activities. I assume and understand the risk associated with such activities and/or classes.

Further, I realize and understand that I assume full responsibility hereafter for any medical expenses arising as a result of any such injury resulting from, or associated, with my participation in these activities. I hereby consent and give permission for the above-named (Participant) to receive emergency care if necessary, and agree to take responsibility for all cost incurred.

Therefore, with the full knowledge and appreciation of the risks involved, and in order to allow my participation in classes and related activities with DANCE QUEST, I hereby release and hold harmless DANCE QUEST, its agents, staff, officers, trustees, owners, representatives, chaperones and faculty from all claims, responsibilities, or demands of any nature, including injuries or damage resulting from my participation in the aforementioned dance classes or related activities.

Further, I give permission for use of photos, videos, Film or other media which may include the participant named above for use in promotional media such as our website, newspapers, magazines, television broachers, flyers or other materials used to inform or advertise the activities of DANCE QUEST. I understand that such media involvement carries no payment or compensation, nor any cost to the participant, student or guardian.

Registration Fee A non-refundable annual registration fee of $30.00 is due per participant in order to secure each participant's position in our program.

1st Tuition Payment The 1st installment payment is due per class per participant in order to secure each participant's position in each class.

Tuition Fees Tuition rates are for the full season (September-June), not by the number of classes in any giving month. Tuition fees are to be paid monthly unless previously arranged with Dance International, Inc. management. Tuition is a yearly amount divided into equal payments. Monthly tuition is calculated according to an annual fee and divided into monthly payments for your convenience. Monthly tuition WILL NOT be pro-rated.

Recurring Electronic Credit/Debit Card Payments Recurring credit/debit card payments are recommended (see recurring payment authorization form). Should you chose not to set up recurring payments, it is your responsibility to review and understand our tuition payment policies.

Non-recurring Electronic Credit/Debit Card Payments Tuition payments are due on or before the 1st of each month. A $10.00 late fee will be assessed on all payments received after the 1st of the month. Any non-payment after the 10th of the month will result in the automatic removal of participant from our roster. Full month tuition and the $10.00 late fee are required to reinstate the participant's placement in class(es). Although we may attempt to place reminder calls that payment is late or participant is being removed from a class roster, it is not our policy to do so. It is your obligation to contact us if there are extenuating circumstances concerning the same.

Return Checks NSF on paper checks, auto-debit, or auto-charge payments will incur a $20.00 NSF fee and must be resolved within 10 days of receiving NSF notice.

Enrollment Upon enrollment, the participants name will automatically be carried over to the following month's attendance roster. Should participant choose to withdrawal from our program, a 30 day advanced written notice is required. If notice is not received, you will be responsible for all months of tuition due until written notice is provided. Phone calls or discussions with instructor do not replace written notice policy.

Costume Fees Costume fees are included within the tuition fees. Costume(s) are required for participant to participate in recitals/performances. If for some reason your costume fee has been calculated separately, all costume fees must be paid in full prior to the costume being order. If costume payment is not received prior to the mass order, a costume will not be ordered for your participant and an expediting fee will be charged to ensure proper delivery time. If for some reason the participant is not planning to complete the year, you must notify us in writing prior to November 15th or a costume will be order and you will be responsible for costume fees regardless of participation.

Attendance Dance Quest International, Inc. honors major holidays and school calendars. The monthly fees have been set with this in mind. Therefore, there is no absentee credit for these days. When participant is absent from his/her class(es) we cannot reschedule a make-up class. Please contact us for any extended absenteeism (Illness/Injury). Dance Quest International, Inc. DOES NOT make-up classes due to acts of God (Hurricanes, Tornadoes, ETC.)

Refunds Refunds are issued only if and when Dance Quest International, Inc. cancels a class due to low enrollment. A class minimum of eight (8) must be reached.

Credits Credit vouchers will be issued when a schedule change is initiated. Vouchers may be applied to any Dance Quest International, Inc. tuition and must be redeemed within one (1) year.

By Registering online you are agreeing to the Liability Waiver, Media Release, Policies and Conditions stated in our Policy form. Using the online tool is as legally binding as signing and initialing our policy page.

Registration fee, 1st tuition payment, and Recurring Payment Authorization.

Completing the following section is optional, but please keep in mind that in order for participant(s) to be enrolled and to reserve his/her spot in a dance class, the registration fee and 1st tuition payment must be received prior to his/her start.

Please be aware that should you choose to enter your information in this section, your account will be charged the appropriate amount nessasary to secure the participant's or participants' postion in a class or classes.

By completing this section you indicate your awarness of all immediate and future charges.

Please contact us if you have any questions.

Recurring Payments Will Make Your Life Easier:

It’s convenient (saving you time and postage)

Your payment is always on time (even if you’re out of town), eliminating late charges

Here’s How Our Recurring Payment Program Works:

You authorize regularly scheduled charges to your Credit/Debit Card Account. Your card will be charged for the tuition amount you selected above (minus the registration fee) each billing period. For example, If you select the option of the registration fee + 1st tuiion payment, your recurring charge amount will be $58.00 for the remaining 9 months. A receipt will be emailed to you and each charge will appear on your statement. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

Name On card

First NameLast Name

Card Holder Email (to receive monthly receipt)

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Card Holder Phone

Area CodePhone Number

Card Type

Card Number

Card Expiration (MM/YY)

CSC # (3 digit # on back of Visa/MC, 4 Digit # on front of AMEX)

Enter the message as it's shown

Payment Plan preference. Please contact us to discuss our many payment options.

Refered by a friend or relative? Please enter their name in the space provided.

Dancer's name

To register a sibling, please click on the "Sibling Information" Button at the bottom of this form.