6TH POSITION DANCE COMPANY Registration Form
Registration form for 2018-2019 dance studio classes.
Email address *
Student Name *
Your answer
Student Age *
Your answer
Student Birthdate *
MM
/
DD
/
YYYY
Parent Name *
Your answer
Mailing Address *
Your answer
Telephone: *
Your answer
Emergency Contact: Name & Telephone *
Your answer
How did you hear about us? *
Required
Classes: 2.5 - 4 years old
Classes: 5 - 7 years old
Classes: 6 - 12 years old
Classes: 8 - 12 years old
Classes: Teen - Adult (13 and Up)
Dance Class Tuition *
Required
Leotard: Indicate Student Size *
Dance Tights: Indicate Student Size *
T Shirt Size: Hip Hop Students Only
As the parent/guardian completing this application I agree to allow 6th Position Dance Company to use my child's image in connection with promotional advertising. *
I authorize 6th Position Dance Company to automatically deduct the monthly tuition by credit card on the 20th day of each month. *
Credit Card Type *
Credit Card Number *
Your answer
Expiration Date *
Your answer
Security Code *
Your answer
Name as it appears on the card *
Your answer
Credit Card Billing Address *
Your answer
Release and Authorization *
Child Physician: Name & Telephone *
Your answer
Insurance Company & Policy Number *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service