Ella Marie School of Dance - 2022-2023                 Pre-Registration Form
It’s time to pre-register for September!  Please use the link below to fill out the pre-registration form.  You will receive a confirmation email, and after the recital, you will receive your fall schedule.  

Please fill out one form for each dancer by clicking “Fill out another form.”

A confirmation email will go out before payment is processed.

* Pre-registration does not guarantee your first choice of day and time.  
* Registration is $25 per class and is non refundable.
* Lyrical students must also register for ballet and be 8 years of age or older.

Please note: Class size limits will be strictly adhered to.  Please make sure to register as soon as possible.    
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Child's First and Last Name *
Date of Birth *
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Address *
City *
Zip *
Phone Number *
Cell Phone Number
Student's Email
Emergency Contact *
Relationship *
Phone Number for Emergency Contact *
Preferred Email *
Back Up Email
Any medical conditions/allergies we should be aware of
I wish to enroll in the following class (check all that apply) *
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Please provide two days of the week you wish to take class *
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Please provide a time of day you wish to take class *
Comments
Payment Procedure
We will charge your credit card (Master Card or Visa only) on the first of the month from September through June.
Charge the card we have on file? *
Card Number
Expiration Date
Cardholder's Name
Signature - By signing I understand and accept the payment policies *
Today's Date *
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