Student's Name

First Last

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Choose Your Class*

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Preferred Start Date?*

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Age*

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is this Student UNDER or OVER 18 years of age?*

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Parent #1 Name

First Last

Parent #2 Name

First Last

Primary Email*

Primary Phone*

Is this a mobile phone?*

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Do we have permission to message you about ADI school related matters?*

Please tell us your mobile phone carrier?*

What is your preferred communications method?*

Which is the fastest and most reliable way to message you with school communications?

Secondary Phone

Emergency Contact Name*

Emergency Contact Phone*

Please list any physical limitations or serious past injuries. If none, write none.*

Please tell us what dance experience level is. Choose answer that best describes where you are today.*

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Please tell us where you have studied dance and how long, if any.

What do you want out of your class(es)? What are your goals?*

Please list all of the reasons why you chose our school?*

Please tell us how you FIRST learned about American Dance Institute?*

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Please explain what other way you learned about our school?

What was your experience using our website?*

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Please explain Too Cluttered? Thanks :)

How might we improve navigation?

Any suggestions? :)

What device are you using to REGISTER for this class?*

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Terms of Use*

Yes, I agree to ADI's terms of use
No, I do not agree to ADI's terms of use.

1. I agree to participate/let my child participate in American Dance Institute’s classes and hereby release American Dance Institute, it’s owners, officers, instructors and employees from liability for any injury I/my child may suffer as a result of my/their participation in classes and community events that we participate in. 2. Class size is limited. Tuition (partial or full) must be paid in advance to reserve a spot in any class. If you choose our payment plan, you are liable for the full tuition once we reserve a space for you in class. Because we limit class size, we cannot credit you for missed classes. Make up classes are permitted within the same session. Check with instructor for appropriate make up classes. If a student has to withdraw due to medical reasons, credit towards another quarter will be given with a valid doctor’s note. You will be charged for all classes until ADI is notified of medical circumstances. 3. I hereby authorize American Dance Institute to publish photographs taken of me, and or my child for use in the ADI’s printed publications, promotions and website. 4. I acknowledge that since my participation in publications and websites produced by ADI is voluntary, I will receive no financial compensation. 5. I further agree that my participation in any publication and website produced by ADI confers upon me no rights of ownership whatsoever. I release ADI, its contractors and its employees from liability for any claims by me or any third party in connection with my participation. 6. I agree to write and post a review about this school on one or more aspects that I find appealing and to share that review on Google, Facebook, Yelp or other social media I use.

Your comments, questions, or special instructions.

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