Dancercise Kids Participant Registration Page

New Child Registration

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. Need to add a child instead? Use this form to add a child to your existing account.

Parent (Your) Information

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Child Information

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Child Care / School Information

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Site Information

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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.

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Credit Card Information

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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.

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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

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