Registration FORM

Dancer's Name

Dancer's Age

Dancer's School

Parent/Guardian

Address

Address 2

City

State

Zip Code

Email Address

Cell Phone

Other Phone

Emergency Contact

Emergency Phone

Allergies/Health Concerns

Dance Experience Dance ExperienceNoneLess Than 1 Year1-3 Years3-5 Years5+ Years

If yes, Where?

Classes (List Day, Time & Class Name)

Parent's Name

Dancer's Name

Parent's Signature (Type full name to sign)

Date (MM-DD-YY)

I agree to all tuition, recital and registration policies & due dates. I agree to all tuition, recital and registration policies & due dates. Yes No

Number