Please select a dance card and at least one week above before completing the form.

2 Parent / Guardian Information

Fields marked with * are required.

Parent / Guardian First Name *

Parent / Guardian Last Name *

Phone *

Email Address *

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Student *

Authorized Pickup Person(s)

List anyone authorized to pick up your child besides yourself.

Authorized Pickup Person(s) Separate multiple names with a comma

Student Information

Student One

First Name *

Middle Name

Last Name *

Date of Birth *

Gender

Girl

Boy

Student Two Optional

First Name

Middle Name

Last Name

Date of Birth

Gender

Girl

Boy

3 Payment Information

Select a dance card above to see your total.

Who is Paying? *

Parent / Guardian

Someone Else

Billing First Name *

Middle Name

Billing Last Name *

Payment Method *

Credit Card 3% surcharge

Debit Card $1.00 per student

eCheck No fee

Your payment information is encrypted and processed securely.

Cardholder First Name *

Middle Name

Cardholder Last Name *

Card Number *

Month *

Year *

CVV * 3 or 4 digits on back of card

Billing Address *

City *

State *

Zip Code *

Billing Email *

Alternate Billing Email

Billing Phone *

I authorize Seaside Dance Studio to charge my card, and I agree to pay, for this order. *

Your bank information is encrypted and transmitted securely.

Routing Number *

Account Number *

Account Type *

Checking

Savings

Account Holder Name *

Account Holder Type *

Personal

Business

Memo / Invoice Reference

Billing Email *

Alternate Billing Email

Billing Phone *

I authorize Seaside Dance Studio to debit my account to pay for this order. *

Automatically renew this package Your package will renew each period until the end date. You can cancel auto-renewal anytime.

End Date Default is end of school year. Change if needed.

How did you hear about Seaside Dance Studio?

Subscribe to SeaMail! Yes! Keep me informed about Seaside Dance Studio classes and events!

I understand that dance is a physical activity that carries a risk of injury. As the parent or legal guardian of the student listed above, I confirm that my child is physically able to participate.

I accept full responsibility for any injury or medical condition that may arise from participation and agree to hold Seaside Dance Studio, its owners, instructors, staff, and affiliates harmless from any claims, injuries, or damages.

I understand that a physical waiver may also be signed in person, but this agreement remains valid regardless.

I also acknowledge that:

Participation is voluntary
Students are expected to behave respectfully toward instructors and other participants
No participant is required to interact with any other participant

I grant permission for photos or videos of my child to be taken during classes and used for promotional purposes without compensation.

By submitting this form, I confirm that I am the parent or legal guardian of the student and agree to these terms.

I agree to the Terms and Conditions *

Questions? Call or text (772) 828-0766

Kids Dance Classes

Choose a Dance Card

2 Parent / Guardian Information

Student Information

3 Payment Information