PYD Community Dance Registration
Please complete the following form to register your child/teen for Portland Youth Dance's Community Dance Program
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Email *
Welcome to the Portland Youth Dance Family
Thank you for your interest in Portland Youth Dance. FMI on who we are or for upcoming programs check out www.portlandyouthdance.com and "Like" us on FB & Instagram.  Upcoming classes include:

Mixed Ability Inclusive Dance | November 6- December 18 | Thursdays 5:30pm-6:30pm at Strive studios

Classes are FREE and will be located at Strive Studios 202 Warren Ave. Portland, ME.  Donations are welcome. 

Suggested donation for those that would like to donate is $75/session but absolutely no required. This is for those that have the means to donate and would like to know an amount, we appreciate it.

Donations accepted first day of class. No one turned away for lack of funds. FMI email elizabeth@portlandyouthdance.com
Dancer's Name *
Dancer's Age *
Gender
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What Classes are you registering for? *
Dancer's Race/Ethnicity (Check all that apply) *
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Parent/Guardian/Caregiver Name
Parent/Guardian/Caregiver Phone Number
Address *
Email *
Do you meet childcare subsidy income requirements?(Family of 1 < $40,000, 2 < $53,000, 3 < $65,000, 4 < $77,000, 5 < $89,000, 6 < $102,000, 7 < $104,000, 8 < $106,000, 9 < $108,000, 10 < $110,000) *
School *
Emergency Contact Name *
Emergency Contact Phone *
T-shirt Size
Any medical conditions, restrictions, allergies, big life changes or anything at all we should know about that will help our teachers support and keep your child/teen safe:
Do you need help translating into another language? If so, what language?
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