Registration Form
2020-2021 Children's Dance Program
* Required
Student's First and Last Name
*
Your answer
Student's Gender
*
Male
Female
Student's Age and School Grade
*
Your answer
Student's Membership Status
*
New Student
Returning Student
Parent's First and Last Name
*
Your answer
Parent's Contact Phone Number
*
Your answer
Parent's Email Address
*
Your answer
Student's Allergies
*
Your answer
Other Medical Conditions
*
Your answer
Emergency Contact Name & Relationship
*
Your answer
Emergency Contact Phone Number
*
Your answer
Classes/Enrollement - check all that apply
*
Creative Dance/Ballet (ages 3-6)
Ballet/Tap/Jazz (K/1st)
Lil Breakers Hip Hop (ages 4-6)
Ballet (age/experience appropriate)
Hip Hop (ages 7 and older)
Urban Choreography (ages 7 and older)
Tumbling Tricks (ages 7 and older)
Dance Team (must audition in August & also take Hip Hop or Ballet)
Tap (age and experience appropriate)
Modern Jazz (Middle School or High School & must also take Ballet)
Adv Modern Jazz (must also take Ballet)
Required
Agree to Registration Fee (nonrefundable)
*
Yes, charge the $25 New Student Fee
Yes, charge the $20 Returning Student Fee
Credit Card Number & Exp Date
*
Your answer
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