Dancefx ATHENS Registration Form

Dancer's Name *
Dancer's Name
Dancer's Birthdate *
Dancer's Birthdate
Street Address *
Street Address
Phone Number *
Phone Number
Any option other than autopayment with a card on file requires an additional $5 monthly processing fee. Any tuition payments received after the 5th of the month for youth dancers or the 19th of the month for adult dancers automatically incurs an additional $15 late fee.
Please indicate your credit card number, expiration date, security code, and billing zip code if you would like to use a card as your method of payment.
Would you like us to save this card information on file to be used in the future? If you select "no" the information will be disposed immediately following the initial charge. Card information kept on file is encrypted as soon as it is saved on the dancer's account.
Thank you for registering yourself or your dancer at Dancefx! Please note that by submitting your electronic signature above, you are providing an electronic mark that is held to the same standard as a legally binding equivalent of a handwritten signature provided by you. Your registration will not be completed until payment has been received, and we must have a signed liability waiver on file prior to the dancer's first class. Please contact Cheryl@dancefx.org, call our front desk at 706-355-3078, or visit the studio during business hours to submit information for payment if you have not done so within this form. *