Everbrook Academy Registration

Registration Form

* Indicates required field

Parent's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Email *

Secondary Email *

Phone Number *

Child's Name (Please note: If registering more than one child you will need to fill out a separate registration form for each child) *

First

Last

School Name *

Classroom name (example: PK4, PK3, Kindergarten) *

Gender *

Female Male

Choose Any *

Kinderdance with Me 13-24 months Kindertots 2 years old Kindergym 3-5 years old

Emergency Contact *

First

Last

Emergency Phone Number *

I have read and agree to all policies, terms and conditions, as outlined in the Policies page of the Kinderdance® Manhattan and the Bronx website. Click here to open Policies *

Yes

Click here for Policies Page

I realize that any program such as Kinderdance® and its affiliated programs which involve movement and motion can result in physical injury. I permit my child to participate in Kinderdance® and release Kinderdance® International or local Kinderdance® franchisees from all liability for injury to my child from his/her participation in this program. Furthermore I agree to allow Kinderdance® International or local Kinderdance® franchisees to use photographs and/or video of my child for Kinderdance® web-sites and promotional purposes without compensation to my child or myself. I have read and agree to this liability waiver. *

Yes

Submit

Payment

Fall session of classes at Everbrook Academy starts on September 21, 2018 and costs $300 for 18 classes
Parents can pay four ways:
1. Mail a check made out to Kinderdance and send with a printed registration form to:
Kinderdance
645 West End Ave #1F
New York, NY 10025

2. Pay online through Venmo. Look up Carol Baird, profile pic is Kinderdance logo

3. Pay online via Chase Quickpay.
You do NOT need to have an account with Chase to use this service
My recipient email is KinderdanceNYC@aol.com
Totally safe, neither of us will see any account information.
Click here to enroll in Chase Quickpay

4. Pay by credit card using the button below

Kinderdance/Kindergym Classes at Everbrook Academy, Fall Semester

$300.00

Kindergym, Kindertots, or Kinderdance With Me classes at Everbrook Academy

Credit Card Payment