N2 Dance Online Payment

N2 Dance Spring 2023 Registration

First Name of Student*

Last Name of Student*

Age (if under 18). If adult just write "adult"*

Parent Name (if under 18). If adult just write "n/a"*

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

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

Phone # (Parents phone # if under 18)*

Teen Student Cell Number (ages 13-18)

Performing

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yes

Classes*

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

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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.*

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I agree with the above statement

I 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*

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I agree with the above statement

I 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

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

If your registration form is successfully sent you will see a message above telling you it was sent.

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.