Fall Registration Form
Email address *
Student Name: *
Your answer
Referred by:
Your answer
Student Date of Birth: *
Student Age *
Your answer
Student Shoe/Clothing Size
Your answer
Parent or Guardian Name: *
Your answer
Parent or Guardian Cell #: *
Your answer
Address: *
Your answer
Allergy/Medical Concerns
Your answer
Please choose all the classes you would like to register for by age
Dance with Me (Walking to 2.5)
Pre-School ( Age 2.5-3)
Mini Ballet/Tap (Age 3-4)
Level 1 (Age 5-6)
Level 2 (7-9)
Level 3/4 (Ages 12-18)
Are you interested in signing up for Lyrique Dance's Competition Company
Please list any additional classes or class times you would be interested in:
Your answer
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