N2 Dance Online Payment

N2 Dance Fall 2022 Registration

First Name of Student*

Last Name of Student*

Age (if under 18)*

Parent Name (if under 18)*

Email Address (VERY IMPORTANT- main form of communication)*

Facebook Messenger Name (to be used for N2 Dance class group chats)

Home Phone

Cell Phone (Mother/Father/Student)

Performing

Will you be participating in our end of semester performance tentatively Dec 1 & 2 (possibly Dec 9 & 10)? Please note there will be mandatory rehearsals the 2 nights previous to the show.

yesno

Classes*

List all of the classes you are enrolling in.

Payment Method (must be received by pre-registration deadline to avoid late registration fee)

Online Credit Card/Debit Card/Pay Pal payment (see below)Check (Make payable to N2 Dance, write student name/classes on check, mail to: N2 Dance, RR3 #1216, Pahoa, 96778)

Who Can We Thank for referring you to us?

Liability Waiver: I certify that I am 18 years or older and am the student or legal guardian of the student registering on this registration form. I hereby assume the risk of any injuries and any loss of property that may occur while receiving instruction from or performing with N2 Dance. I will not hold N2 Dance, its instructors, or YWCA of Hawai'i Island responsible for any personal injury or loss of property that may occur while receiving instruction from or performing with N2 Dance.*

I agree with the above statementI disagree with the above statement

Media Waiver: I give permission for photos of myself/my child to be used with out compensation by N2 Dance for web pages and/or promotional purposes*

I agree with the above statementI disagree with the above statement

Name of person filling out this form/ Relation to student

Student Mailing Address

Student School & Grade or Occupation

Additional Information, or Comments

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Please make sure that you press the SEND button above BEFORE paying for classes.

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Credit Card or Paypal Payment for Classes

Instructions when paying for multiple family members:
-Input information for 1 student at a time. Remember the number of classes per week is per student not per family.
-make sure to indicate the name of student paying for and the classes they are taking each time you add to the cart.
-The family discount will be refunded to families after the start of the semester.

N2 Dance T-shirt Order

For each t-shirt that you order please be sure to indicate who the shirt is for.