Please select Studio Location
Name of Student
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Name of Parent/Guardian (#1)
*
If you are an adult filling out this form please write your name again.
First Name
Last Name
Cell Phone of Parent/Guardian #1
*
Cell Phone Number - If an adult registering yourself please put your phone # here.
(###)
###
####
Name of Parent/Guardian #2
First Name
Last Name
Cell Phone of Parent/Guardian #2
(###)
###
####
Email of Parent/Guardian #2
Name of Emergency Contact
*
Someone to reach if a Parent/Guardian is unavailable.
First Name
Last Name
Cell Phone of Emergency Contact
*
(###)
###
####
Home Address of the Dancer
*
You must fill in the country - Squarespace requires. :)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name of person to be billed if different
Name of the person to bill if not Parent/Guardian #1
First Name
Last Name
Billing Email Address if different
Class Selection List
*
Please select the class(es) you wish to enroll your dancer/yourself
Comments or Questions
How did you hear about us? Comments or Questions
Payment Options
*
Payments to be made on or before
Signature Acknowledgement
*
I agree to the Statement of Understanding and to make all payments associated with the class my dancer or myself are taking.
First Name
Last Name
Date
*
MM
DD
YYYY
