Private Lesson Registration

Private Lesson Registration Form

After your submission, we will email or call you to confirm registration. If you do not hear from us in 2 business days, please send an email to [email protected] Thank you!

Registration Form Information
Please be aware: By filling out the "Registration Form," you are committing to the private lessons as agreed to via email/private lesson request.
General/Contact Information
Address*
Street Address Address Line 2 City State ZIP Code
Primary Parent/Guardian*
First Last
Primary Parent/Gaurdian Phone*
Primary Parent/Gaurdian Email*
Secondary Parent/Guardian Name
First Last
Secondary Parent/Gaurdian Phone
Secondary Parent/Gaurdian Email
Please add Secondary Parent to:
Emergency Contact Name and Number (If primary and secondary cannot be reached)*
How Did You Hear About Us?
Payment Information
Square Invoices: Please enter the email address you would prefer invoices to be sent:
Student Information/Class Selections
First Student Name*
First Last
Age as of 8/1/2023*
Date of Birth*
Does dancer have any allergies (severity?), injuries, or anything else you would like to disclose so we can provide the safest environment possible for your dancer?
Notes
Acknowledgement of Agreement*
• By signing below, I verify that all information I provided is thorough and true. I understand I am committing to the classes I've selected and all fees. • I also acknowledge that I have read, understand, and agree to comply with all of the terms, procedures, policies including tuition and applicable fees, studio/lobby and classroom etiquette (in regards to students as well as parents/guests), dress code expectations, withdrawal procedures and fees, cancellation policy, as well as due dates and all other policies afore mentioned in this brochure as well as se-dance.com. • I agree to make payments at the designated time and agree to any late fees according to SESD policy. *If signed up for ACH withdrawals, I give SESD permission to withdraw agreed upon amount for the full season, unless written notice of student withdrawal is presented to and accepted by SESD/director. • I understand that Tuition, Registration, Showcase, and Costume fees are non-refundable. • I understand that students are expected to attend each week in order to be promoted, participate in recital and performances, etc. Missed classes can be made up; however, SESD can never deduct from tuition payments. • I give my permission for SESD to use any and all photos and/or videos of said student in various media including but not limited to web images and various forms of advertisement. • Parent/guardian of minor or above student recognizes the existence of personal injury in said course of instruction and that they are assuming the risk without liability to Creative N’rgy INC. DBA Southeast School of Dance. • By signing below, I commit to the aforementioned season and realize that failure to comply with any of the above policies may result in consequences including dismissal from Southeast School of Dance.
Today's Date*
MM slash DD slash YYYY

Private Lesson Registration Form

Registration Form Information

General/Contact Information

Payment Information

Student Information/Class Selections