Summer 2018 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)

BE SURE TO LET US KNOW IF YOU WERE REFERRED BY A FRIEND WHEN COMPLETING THE REGISTRATION FORM! EARN A DISCOUNT TOWARDS TUITION!

* Required fields
Name *
E-mail Address *
Address *
City *
State *
Zip Code *
Home Phone *
Cell Phone
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 Type *
Student 1 Class 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 Type
Student 2 Class 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 Type
Student 3 Class Choice
Student 3: Are there any health issues of which we should be aware?
Comments (example: list multiple classes for one student here)
How Did You Hear About Us? *
Referred By...


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Copyright 2018 Lake Area Dance Center, LLC. All rights reserved.