Dance Registration

Student Name *

Student Telephone

 *
Email Address * Student Cellphone
Address 1 * Address 2
City, State, Zip * Years Danced
Gender * DOB
Age (9/1/10) Grade (9/1/10) 
Medical Conditions      
Emergency Contact (non-parent) * Contact's Tel# *
Emergency Contact (non-parent) * Contact's Tel# *
           
Mother's Name Mother's Phone
Mother's Address 
(if different)		     Mother's Cellphone
Father's Name Father's Phone
Father's Address 
(if different)		     Father's Cellphone
Person Paying (if not student or parant)  

Address

  
Referred By:   City, State, Zip  

Class #1    

Class #2    

Class #3    

Class #4    

Class #5    

THERE IS A $3 LATE FEE PER WEEK TO ANYONE WHO PAYS TUITION AFTER THE 1ST OF THE PRIOR MONTH.   TUITION IS DUE SEPTEMBER – JUNE REGARDLESS OF NUMBER OF CLASSES AND PAYABLE THE LAST WEEK OF THE MONTH  NO LATER THAN THE FIRST DAY OF THE PRIOR MONTH.  EXAMPLE: SEPTEMBER TUITION DUE BY SEPTEMBER 1ST.
 
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