Dance Story Hour Registration Form
If this is your first time attending Story Hour with Peoria Academy of Dance and Art, please fill out the registration form below. You may choose the dates you are interested in registering for.
Please indicate on the form if you would like to pay for the classes individually or with a reduced rate punch card option. After registering you will receive an invoice which you may pay online to reserve your spot in class, as well as confirmation of your registration, directions to the studio and additional information on the classes you are attending. 

Note: We aim to respond to all registrations within 24 hours. If you haven't heard from us in that timeframe, please reach out to ensure your registration reached us.
Registering for a class today? After filling out the form, feel free text us at (309) 922-9017 to secure your spot right away.
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Participant Name(s) *
Participant Age(s) *
Adult Name *
Email Address *
Phone Number *
Class(es) attending *
Required
Payment Method(please see our pricing page the website for more information and our pricing system policies)

Individual class pricing:

-Half hour class-$8

-Hour class-$15

-Hour and a half class-$22

Punch card pricing:

-5-hour punch card-$60 ($12/hr)

-10-hour punch card-$110 ($11/hr)

-20-hour punch card-$200 ($10/hr)

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Any food, pet or other allergies, health information or other specific accommodations needed?
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Do you give permission for photos to be taken for the purpose of studio promotions (facebook, instagram, flyers, ect.)?
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Please sign your full name below to indicate you have read and understand the following:

The undersigned, who is one of the parents, who have legal  custody, or the legal guardian, of any student named here above, hereby authorizes the staff of Peoria Academy of Dance and Art, LLC or contracted instructor, to consent to any x-ray, examination, anesthetic, medical treatment, or special supervision, and on the advice of a physician, or surgeon licensed under the Illinois Medical Practice Act.  For any injuries or Illnesses, Peoria Academy of Dance and Art, LLC will attempt to contact me before my son or daughter is treated at any medical office, unless such treatment is so urgent, it must be done, before contact is made.  If I cannot be reached, this authorization is effective.

We will do everything possible to make this experience safe and enjoyable. Peoria Academy of Dance and Art, LLC cannot, however, eliminate all possible risks inherent in these activities, whether from the physical condition of the participant, forces of nature, or conduct of our staff and other students. Possible risks include, but are not limited to accident/and or sickness, without readily available medical facilities.  I hereby assume all of the risks involved and agree to indemnify and hold harmless Peoria Academy of Dance and Art, LLC, and its employees contractors from any and all liability that may arise in connection with my or my child's participation in the activities at Peoria Academy of Dance and Art, LLC and any other areas visited during the classes in which myself or my child is enrolled.  In case of an accident or illness, I will bear the cost of any evacuation procedures and medical care.  I understand that I must provide my own health insurance and agree to assume any financial responsibility for my own and my child's care. *
Code of Conduct & Safe Space Agreement
To ensure a safe, welcoming, and productive environment for everyone, all participants must adhere to the following standards of behavior: 

Respect for All: Treat all humans and animals with kindness, courtesy, and dignity.
Respect for Property: Care for our facilities and the belongings of others. Misuse or damage to property is not permitted.
Appropriate Language & Topics: No swearing or offensive language. Discussions must remain age-appropriate for all participants, including those as young as 2 years old. If you are unsure if a topic is appropriate, it likely is not.
Zero Tolerance for Bullying & Discrimination: We have a zero-tolerance policy regarding bullying, harassment, and discrimination of any kind. This is a safe space for all.
One-Warning Policy: Inappropriate behavior will result in exactly one warning. Continued failure to comply will lead to immediate removal from the program.
Right to Dismiss: We reserve the right to ask any participant to leave if their conduct disrupts the safety or learning of others. 
Open Communication & Issue Resolution
We are committed to resolving all problems in a constructive manner. If you feel you are experiencing discrimination or are uncomfortable with any behaviors from teachers or students, please discuss this directly with Kyla via email, text, or in person. We value your feedback and will work with you to ensure a positive experience for everyone. 
By signing below, I acknowledge that I have read, understood, and agree to uphold this Code of Conduct and share this information with any guests or children I may bring to class.
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Have you participated in classes or camps previously at Peoria Academy of Dance and Art, Art with Kyla, or Wheel Art Pottery Studios?
How did you hear about us?
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