Summer Studies Registration

Summer Studies Registration Form

General Information

This form is the application form for domestic students. Please Click HERE for the international student application form.

Are you under the age of 18?

YesNo

For applicants below 18 years, a Parent/ Guardian will be required.

Yes, I am the Parent/ Guardian

Parent/Guardian's First Name

Parent/Guardian's Last Name

Parent/Guardian's Email

Parent/Guardian's Telephone

First Name

Last Name

Telephone

Age

Date of birth

AddressBuilding no., Street

Apt #

City, State/Province

Zip/Postal Code

Choose your program

Desired start date

Monday, June 1st Wednesday, July 1st Monday, August 3rd

Choose your Package:

52 Drop-in Class (including 4 Master Classes of your choice)47 Drop-in Class + one of "The Sessions" (a 5-Class Series)48 Drop-in Class + an Absolute Beginners Workshop (a 4-Class Series)

How did you hear about the Program?more details

0 /

Scholarship

Have you received a scholarship?

YesNo

When & Where?more details

0 /

Copy of your scholarship award or letterupload

Upload

Waiver, Release, Policy

Please carefully read the Liability Waiver, Media Release and Refund/Cancellation Policy below and sign. If you are under 18, your parent or legal guardian must sign as well.

Media Release

I hereby give my consent to Peridance Capezio Center to use my name and any form of dance-related media acquired during my study (video, photography, voice, etc.) for publication, advertising, marketing, promotional campaigns, etc. I understand that I will not be compensated by Peridance or a third party should Peridance decide to use these materials.

Liability Waiver

I am participating in Peridance’s training program and understand that dance training comes with a risk of injury. I also understand I cannot hold Peridance Capezio Center or any member of its staff liable for any injuries that may occur as a direct result of participating in dance classes, rehearsals, seminars, activities, etc.

Refund/Cancellation Policy

Peridance Capezio Center does not offer any refunds except in extenuating circumstances that must be approved by management. In these special cases, students may be offered class credit only. This credit can be used towards any activity at Peridance Capezio Center. There are no refunds for missed or skipped classes. Peridance Capezio Center can only issue class credit if the student withdraws from a single class within the first 15 minutes of class.

Student's Full Name

Today's Date

Student's SignatureI agree to the terms and conditions

(Sign Here)

Clear Signature

Parent/Guardian's Full Name

Parent/Guardian's SignatureI agree to the terms and conditions

(Sign Here)

Clear Signature

Payment

Program Tuition

Total: $898.00 (non-refundable)

Payment method

Credit Card (+3.1% processing fee)Wire TransferCheck or Cash

Credit Card

You will receive an e-invoice shortly. Please make the payment to complete the registration. Check your spam folder if you don't see the invoice.

Wire Transfer

Payment should be paid in 3 days.

Account Name: Peridance Center LLC

Account No: 4984525413

Bank Name: Citibank, N.A.

Swift Code: CITI US 33

Bank Address: 52 East 14th Street, New York, NY 10003-4140 USA

Routing No: 0210-0008-9

*Applicant name must be included in the memorandum for all wire transfers, or may be subject to delays.

Check or Cash

Payment should be paid in 3 days.

- All checks and money orders must be made out to “Peridance.” Include applicant full name in the memorandum.

- Send a check to Peridance Capezio Center Attn: Your program name, 126 East 13th Street New York, NY 10003.

- Do not mail cash. Cash option for applicants that wish to pay in person while in the United States at the time of application.

$ [898*field29+898]

Stripe Card Placeholder

Apply

*By clicking Submit Form, you are agreeing to the Terms and Conditions