2019-2020 SSSOD Dance Year Registration Form
Please use this form to register for the 2019-2020 dance year with the Newman YMCA's, Shooting Stars School of Dance.
Email address *
Child's First Name *
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Date Of Birth *
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Age *
Your answer
Gender *
Grade Entering in Fall 2019 *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Parent/Guardian Contact Name (First and Last) *
Your answer
Primary Parent/Guardian Date of Birth *
MM
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DD
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YYYY
Primary Parent/Guardian Address *
Your answer
Primary Parent/Guardian Phone Number. Please include area code and if it is your cell, work or home number. *
Your answer
Primary Parent/Guardian Contact Email (we suggest something that is not @aol.com as it has been brought to our attention that addresses with this domain are not always received due to security blocks from AOL) *
Your answer
Primary Parent/Guardian Additional Phone Number(s). Please include area code and if it is your cell, work or home number. *
Your answer
Secondary Parent/Guardian Name (First and Last) *
Your answer
Secondary Parent/Guardian Date of Birth *
MM
/
DD
/
YYYY
Secondary Parent/Guardian Address
Your answer
Secondary Parent/Guardian Phone Number. Please include area code and if it is your cell, work or home number.
Your answer
Secondary Parent/Guardian Email
Your answer
Secondary Parent/Guardian Additional Phone Number(s). Please include area code and if it is your cell, work or home number.
Your answer
#1 Emergency Contact/ Authorized Pick-up *
Your answer
#2 Emergency Contact/ Authorized Pick-up *
Your answer
#3 Emergency Contact/ Authorized Pick-up *
Your answer
2019-2020 Enrollment Agreement (Please Check All) *
Required
I clearly understand all of the policies and procedures listed above and in the handbook for the 2019-2020 dance year. *
Name of person filling out this form *
Your answer
Does your child have any allergies? *
Your answer
Does your child take any medications? *
Your answer
Are there any special instructions that we should be aware of (disability, unauthorized pick-ups, special learning requirements, etc.) *
Your answer
18 Months- 2 Years Old Classes
3 Years Old Classes
Pre-K and Kindergarten Classes (4-6 Years Old)
1st & 2nd Grade Classes (6-8 Years Old)
3rd & 4th Grade Classes (8-10 Years Old)
5th & 6th Grade Classes (10-12 Years Old)
7th & Up Classes (12 Years Old and Up)
9th & Up Classes (14 Years Old and Up)
Adult Classes
Would you or your child like to participate in a private lesson in the Fall?
If your child is interested in taking a private lesson, please indicate the style your child would like to perform/study, your instructor preference (list at least two) and the day and times that work well for you. Additionally list the dancers you plan to have the lesson with if you are enrolling in a duo/trio or small group. Please note this does not guarantee your selected time or instructor.
Your answer
2019-2020 Fall Pricing for Reference
Please select your PAYMENT METHOD: If you choose "ACCOUNT ON FILE" and have multiple accounts on file you you must specify which account you wish to use. If you do not specify the account used for your YMCA membership (members) or past dance tuition drafts (non-members) will be used. If you are new to the program or would like to add a new account we will be contacting you shortly. *
Required
COSTUMES PAYMENT PLAN (OPTIONAL): Would you like to be set up on a 6 month costume payment plan? The plan will be set to draft on the date you choose for 6 consecutive months (August-January). Costume fees for families enrolled in the costume payment plan are as follows: $50 per general classes, $55 per Combo II/Combo III, Lyrical/Hip Hop. You will have until September 30, to pay balance in full and receive these discounts if you opt out of a payment plan.
RECITAL FEE PAYMENT PLAN (OPTIONAL): On February 1, 2020 a fee of $75 will be auto-drafted for all students participating in the recital. This fee covers the DVD, T-shirt & Trophy. Would you like to set up a 6 month payment plan for this fee instead of a one time draft? *
If you selected a costume or recital fee payment plans, please indicate which day of the month you wish for your costume payment to draft. If a selection is not made costume payments will draft on the 1st of the month.
Your answer
By submitting this form, I hereby understand that I am enrolling in the 2019-2020 dance year for the Newman YMCA's, Shooting Stars School of Dance. Please type the name of the person filling out this form.
Your answer
A copy of your responses will be emailed to the address you provided.
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