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 *
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) *
Please provide two days of the week you wish to take class *
Please provide a time of day you wish to take class *
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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