Summer Online Registration
This form is for registration for our Summer 2011 Dance Programs, described in detail on our
Summer webpage.

If you would like to register for our Fall Season 2011-12, please go to our Fall Online
Registration page.

Summer online registration is a 3-step process that offers families the convenience of not
having to leave home to join the fun at FFDC.

Step 1 is filling out this online form. If you have multiple dancers that you wish to register,
please fill out separate forms for each. This online registration form will put your dancer(s) in
queue for admission into the classes you select below.

In Step 2, you will receive an email invoice confirming that we have received your online form,
verifying the classes in which your dancers are queued, and providing you with a total due, and
payment instructions.

Step 3 is payment. Registration is not complete (i.e. dancers are not enrolled) until tuition
and the registration fee (if applicable) have been received by our office.

Please feel free to call our office at 614-883-5599 or email us at
footstepsfamilydance@yahoo.com, and our staff will assist you with tuition estimates for your
family.

We'll be happy to welcome you into the Footsteps family as soon as all of your paperwork has
been taken care of!
Summer Online Registration Form
Family Account Info
Mom's/Guardian's Name
Dad's Name
Address
City, Zip Code
Home Phone
Cell Phone
Best time of day to call you:
Email Address
Confirm Email Address
Please re-type your email address.
How did you hear about Footsteps?
Referred by:
If a friend or neighbor referred you, please let us
know who so we can thank them with a referral credit!
Event:
If you saw us a public event or performance, please
let us know where.
Student Info
If you have multiple dancers, please submit a separate form for each.
Dancer #1 Name
Female
Male
Birth Date (mm/dd/yy)
Age as of June 20, 2011
Medical conditions that
may affect dancing:
Desired class(es)
Please check all that apply.
Genesis Pre-Dance
Intro Seminars
Genesis 3 (30 min)
1st 3 week session Ballet
Genesis 4-6 Ballet/Hip Hop Combo (60 min)
1st 3 week session Tap
Genesis 4-6 Ballet/Tap Combo (60 min)
1st 3 week session Jazz
Number of weeks (2-6):
1st 3 week session Hip Hop
2nd 3 week session Ballet
2nd 3 week session Tap
Ongoing Ballet
2nd 3 week session Jazz
2nd 3 week session Hip Hop
Ruby (60 min)
Amber (60 min)
1 week session Ballet
Emerald & Ballet Conditioning (60 min/60 min)
1 week session Tap
Sapphire/Onyx & Ballet Conditioning (60 min/60 min)
1 week session Jazz
Number of weeks (2-6):
1 week session Hip Hop
Ongoing Tap
Ongoing Jazz
Beginner (60 min)
Beginner/Tween (60 min)
Tween/Intermediate (60 min)
Number of weeks (2-6):
Number of weeks (2-6):
Ongoing Hip Hop
Ongoing Pointe
Beginner (60 min)
Pearl (30 min x 2 = 60 min
Number of weeks (2-6):
Pointe
Technique/Strengthening
(Topaz-Diamond, 45 min)
Number of weeks (3-6):
Tuition & Payment Info
We will email you an invoice with your full tuition amount. We accept cash, checks, Visa, MC, Discover, & Paypal payments. Your
credit card will not be charged until the invoice has been sent. Please note that registration is not complete until payment
has been received. If you opt to send a check via snail-mail, you will receive a confirmation email when we receive it to let you
know your registration is complete.
If you have multiple dancers/students in your family, please fill out separate online registration forms for
each. Our office will figure the tuition for your family, applying the proper discounts (described on Summer page),
and email you an invoice with your total.

Genesis & Ongoing Classes:
    30 min--$11/class
    45 min--$12/class
    60 min--$14/class
    $10 registration fee

Intro Seminars:
    $45/session + $10 registration fee

Choreography Intensive
    3 weeks--$60
    4 weeks--$76
    5 weeks--$90

Creative Arts Experiences:
    Full-day $250
    Mornings/Afternoons Only $150
    A la Carte $35/session + $5 for any lunch hours noon-1:00 pm
    If you plan to drop your child off early (8:00 am at the earliest) or pick them up late (6:30 pm at the latest),
    please tell us the details here:
Payment method: Check one
Cash (please visit the studio to pay in person)

Check (payable to Footsteps; mail to 8714 Cotter St, Lewis Center, OH 43035)

Paypal (please use the Paypal button on our Downloads page AFTER receiving your invoice)

Credit card (your Visa, MC, or Discover will not be charged until we email your invoice)
Card number
Expiration date
3-digit code on back
Terms & Permissions
Liability Waiver & Permissions
The instructors at Footsteps Family Dance Center, LLC, are safety-conscious, however, I (parent/guardian) understand
that because dance is a physical activity, injuries minor and major are possible for my dancer despite all safety
precautions. I, intending to be legally bound, waive and release Footsteps Family Dance Center, LLC, its members,
instructors, staff, contractors, and volunteers of any and all responsibility for injury or illness. In the event of an injury or
illness, I understand that every effort will be made by the FFDC staff to contact parents/guardians first; if a
parent/guardian is unreachable, the emergency contact person I have provided will be contacted and has my permission
to authorize medical treatment for my student(s). If necessary, I authorize Footsteps Family Dance Center, LLC, to
administer any minor first aid and/or authorize medical treatment. The above-named student(s) has had a medical
examination within the last 12 months and is capable of participating in dance.

I hereby give Footsteps Family Dance Center, LLC, permission to use my child's photos and/or videos in the studio, in
printed materials, and online for marketing and promotional purposes. I understand that my child's name and contact
information will not be published with photos/videos for security reasons.
I agree to these terms.
(Must be checked in order to
participate in any FFDC programs.)
I do not agree to these terms.
Emergency contact info
Info should be for someone other than a parent--of course, we would call a parent first if there were a medical emergency!
Emergency contact person
Relationship to dancer
Phone #
Thank you for joining the Footsteps family for
the summer! We hope your experience here is
all you & your dancer dream of!