Dancercise Kids Participant Registration Page

This secure page is designed for you to register your child for Dancercise Kids classes currently offered by Creative Caterpillar, LLC* at licensed child care facilities and other locations in Milwaukee, WI. You will find it helpful to have a copy of our flyer or other material with you as you complete this form.

Parent (Your) Information

I have an account and am adding a sibling

 

Parent Full Name

   

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First name of primary parent or guardian

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Last name of primary parent or guardian

 

Street Address

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We need your address to confirm your registration

 

City

State

  Select OneCaliforniaAlabamaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming    Zip

 

E-Mail Address

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You must provide a valid e-mail address. You will receive a confirmation at this address, and it is our primary method of non-emergency communication

 

E-Mail Consent

I agree that Creative Caterpillar, LLC (Dancercise Kids) may use this e-mail address to send me eStatements regarding my account, periodic curriculum newsletters and occasional promotions regarding events and offers. I understand that - at any time - I may opt-out of all communications except eStatements using the Safe Unsubscribe link at the bottom of any e-mail. Creative Caterpillar, LLC does not provide your e-mail or other contact information to any other party.

 

Day Phone

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Contact phone number where we can reach you during the day monday to friday

Evening Phone

 

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Evening and/or weekend contact number. Only used to contact you at these times to confirm registration details

 

Cell Phone

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A cell phone number if you would like to provide one for emergency contact purposes.

 

Child Information

 

Child's Full Name

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First name of child you are registering

   

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Last name of child you are registering

 

Child's Date Of Birth

Age of Child (Years) 

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We ask this as a double check on date of birth.

 

Child's Gender

Boy     Girl

 

Child Care / School Information

 

School Code

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Enter the code for the school or center at which you wish your child to participate. This code can be found on the Dancercise Kids flyer or poster or by calling or e-mailing our office. If you don't know it, please provide a description or address of the location in the next field.

Child Care /
School Description

(chars left: 240)

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If you do not have the school code, please tell us as much as you know of the name and address of the child care center or other location where you wish your child to take Dancercise lessons

 

Site Information

 

Terms & Conditions

By checking this box, I am acknowledging that I realize that Creative Caterpillar, LLC offers a comprehensive program of activities for children including various forms of exercise, dancing and tumbling that can result in physical injury. While our instructors make every effort to ensure the children's safety, I will not hold Creative Caterpillar, LLC, its employees or any of its subsidiaries or affiliates liable in the highly unlikely event that my child should sustain an injury. I agree to allow Creative Caterpillar, LLC to use the likeness of my child in photographs and/or video solely for advertising and promotional purposes without compensation to my child or myself.

 

How did you find us?

Select OneDirector/TeacherSchool FlyerWeb SearchGoogle/FacebookReferralDrive ByOther

 

Discounts

Employee   Family   Director  

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Let us know if you think you're due any discounts.

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Let us know if you think you're due any discounts.

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Let us know if you think you're due any discounts.

 

Promotional Code

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Occasionally we offer promotional discounts. Use the code found on the flyer, internet ad or other source to get your discount.

 

Credit Card Information

 

Credit Card Processing

You must provide a valid credit card in order for your child to participate. This is a secure form, and your credit card details are stored immediately and securely at Authorize.net, a reputable provider of credit card services that is approved by all of the major credit card companies for secure storage of credit card data in compliance with the PCI (Payment Card Industry) standards. Creative Caterpillar, LLC does not keep your card number in any form other than via authorize.net's secure services, where your card information is masked and unavailable even to our staff. All classes are billed approximately 2 weeks in advance to your credit card. See our terms and conditions for our refund and credit policy. Upon completion of this form, your card will be charged 1c in order to verify the card information - it will be immediately voided and no charge will remain on your card.

 

Credit Card Type

Select One American Express Discover MasterCard Visa

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Select the type of credit card you wish to use.

 

Credit Card Number

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A valid credit card is required - no dashes or spaces

 

Card Expiration

Month01 - Jan02 - Feb03 - Mar04 - Apr05 - May06 - Jun07 - Jul08 - Aug09 - Sep10 - Oct11 - Nov12 - Dec /  Year20182019202020212022202320242025202620272028

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Select the expiration of your credit card

 

Card Agreement

I agree that Creative Caterpillar, LLC may charge my credit card for any balance due. I understand that classes are billed monthly approximately 15 days before the start of the month and that no refunds will be given, but that I will receive a statement via e-mail approximately 10-12 days prior to my card being billed and will notify you in advance of cancellation or schedule changes. I understand that a one-time $10 registration fee will be applied per child registered

 

Additional Comments

(chars left: 240)

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Enter anything else we need to know, such as allergies etc.

 

Common Questions

• What if I don't know my school code? It's on the flyer you received but if you don't have it, just give us the name and address as best you can in the provided box
• What happens to my card? Your card is sent immediately to authorize.net (we don't even see the number) and we process a test charge of 1c which is immediately refunded
• Why didn't I get a receipt? You should get an e-mail confirmation of registration but we do not bill your card until your child is registered and has a start date, and you will then start receiving e-mail statements
• Why did I get two charges close together? We bill in advance, so we'll bill you for any current month charges when you register and depending on the day of the month, you may be billed then for the following month, or on the 15th of the current month.
• I'm having problems submitting the form. The most common problem is that people forget to check one of the three consent boxes, for e-mail, liability and credit card charges. If you're still having problems, call us, we'll be happy to do this over the phone.