Fall 2018-2019 Online Registration Form

Fall 2018-2019 Online Registration Form

Registration Information includes:

Parent/legal guardian information
Emergency contact information
Student information
(Up to three students, or up to three classes, may be registered at once)

Registering for 8-Week Session Classes? Click here to register instead!

* Required fields
Name *
E-mail Address *
Address *
City *
State *
Zip Code *
Home Phone *
Alternate Phone
	Check this box if you want to enroll in our automatic payment plan option.
Emergency Contact Name *
Emergency Contact Phone *
Student 1: Name *
Student 1: Age *
Student 1: Birthdate (mm/dd/yyyy) *
Student 1: School 2018-2019
Student 1: Grade 2018-2019
Student 1: Years Of Dance *
Student 1: Class Name 1ST CHOICE *
Student 1: Class Day 1ST CHOICE *
Student 1: Class Time 1ST CHOICE *
Student 1: Class Teacher 1ST CHOICE *
Student 1: Class Name 2ND CHOICE *
Student 1: Class Day 2ND CHOICE *
Student 1: Class Time 2ND CHOICE *
Student 1: Class Teacher 2ND CHOICE *
Student 1: Are there any health issues of which we should be aware? *
Student 2: Name
Student 2: Age
Student 2: Birthdate (mm/dd/yyyy)
Student 2: School 2018-2019
Student 2: Grade 2018-2019
Student 2: Years Of Dance
Student 2: Class Name 1ST CHOICE
Student 2: Class Day 1ST CHOICE
Student 2: Class Time 1ST CHOICE
Student 2: Class Teacher 1ST CHOICE
Student 2: Class Name 2ND CHOICE
Student 2: Class Day 2ND CHOICE
Student 2: Class Time 2ND CHOICE
Student 2: Class Teacher 2ND CHOICE
Student 2: Are there any health issues of which we should be aware?
Student 3: Name
Student 3: Age
Student 3: Birthdate (mm/dd/yyyy)
Student 3: School 2018-2019
Student 3: Grade 2018-2019
Student 3: Years Of Dance
Student 3: Class Name 1ST CHOICE
Student 3: Class Day 1ST CHOICE
Student 3: Class Time 1ST CHOICE
Student 3: Class Teacher 1ST CHOICE
Student 3: Class Name 2ND CHOICE
Student 3: Class Day 2ND CHOICE
Student 3: Class Time 2ND CHOICE
Student 3: Class Teacher 2ND CHOICE
Student 3: Are there any health issues of which we should be aware?
Comments
How Did You Hear About Us? *	Current Student Drove By Business Word Of Mouth/Referral Parade/Community Event Print Advertisement Internet Other
Referred By:
We ADD Classes Based Upon Interest! What would you be interested in seeing? (examples: boys-only, Zumba, acrobatics, dancing moms & dads, etc.)
I have read and agree to the Privacy Policy *

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