Online Registration Form

The Fall 2011 Registration form is live. Please feel free to register anytime.

• To register, please fill out this form completely.
• Registration for the fall term must be done online.
• Fill out one registration form per student.

If you have any questions, please email our office at office@iheartcvda.com or you may call (503) 537-3902.

Thank you and welcome!

Online Registration Form - Fall 2011

• Location

• Which location are you registering for?*
  • Newberg
  • McMinnville (in the Dance Studio above the Gallery Theatre)

• Dancer Information

• Name*
  FirstLast
• Dancer Birthdate*
  -if adult, type "adult"
• Medical or Special Needs Info*

• Contacting Information

• Parent Name*
  FirstLast
• Second Parent Name
  FirstLast
• Address*
  Street AddressAddress Line 2CityState / ProvinceZip / Postal CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry
• Home Phone*
  Phone format: (###)###-####
• Parent Cell*
  Phone format: (###)###-####
• Second Parent Cell/Other Contact #*
  Phone format: (###)###-####
• Email*

• Emergency Contact

• Name*
  FirstLast
• Phone*
  Phone format: (###)###-####

• Liability Waiver and Contract

• Liability Waiver - electronic signature*
  Please read and type your full name into the signature line above if you agree to the terms:
  
  I agree to release and hold harmless Chehalem Valley Dance Academy, All Star Dancewear, and anyone providing services for Chehalem Valley Dance Academy or All Star Dancewear from any and all claims of any nature, including, but not limited to property lost, personal injury, or death. I agree to release Chehalem Valley Dance Academy from all claims that might occur at their annual showcase or any othe CVDA event my dancer may be participating in. I understand that teachers may physically adjust my dancer's placement. I will not leave my child under the age of 10 unaccompanied in the lobby, in All Star Dancewear, or outside on the benches of CVDA.
• Policies and Dress Code Agreement*
  By initialing here I agree to the policies listed on the website including the dress code requirements.
• Photo/Video Release*
  • Yes, I give permission
  • No, I do not permit this
  Do you give CVDA permission to use photographs and/or video of your child for marketing efforts?

• Classes

  -Format: Class title, day of week, instructor name
  
  -Please list each class in a separate field
  
  -Dancer’s placements will be verified by the instructor before classes begin in September.
• Class #1*
• Class #2
• Class #3
• Class #4
• Class #5
• Class #6
• Class #7
• Class #8
• Class #9
• Class #10
• More than 10 classes? Enter additional here...
  -please list additional classes here, 1 per line

• Dance History

• Please list any dance experience*
• Please list any specific goals
• Are you a new student?*
  • Yes
  • No

• How did you hear about us?

• *
  • Website/internet search
  • Free class card
  • Bring-a-friend week
  • Drove by CVDA
  • Referral (please list name below)
  • Other (please specify below)
• Referral name or specify other from above:

• Payment

  Make a selection below and we will email you with tuition and payment information within a day or two.
• Select an option*
  • #1 - Registration fee and 1st month's tuition payment
  • #2 - Pay in full for the school year

• Once the registration form is submitted, we will review it and email or call you with any questions within a few days.