Student Name:
Parent / Guardian Name:
Address (INCLUDE City, State, and Zip Code):
Home Phone Number:
Cell Phone Number:
Email Address:
Student Birth Date:
Student Current Age:
School / Grade:
Previous Dance Experience? If YES, Where?
This will be my ___ year of dance: 5th
Emergency Contact Information (Please include Name, Relation to Student, Phone Number, and Address) Please put someone else down other than Parents/Guardian:
Recital T-Shirt Size (Keep in mind dancers will be wearing this in June- you will be billed at a later date ) Child XSmall (4-5)
Child Small (6-8)
Child Medium (10-12)
Child Large (12-14)
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Credit Card Type: (We will be holding a credit card on file. Please note: Credit Cards will ONLY be charged if you have an outstanding balance one week before the recital). All regular payments throughout the year can be paid by CASH, CHECK, or CREDIT(fees applied):
Credit Card Number:
Expiration Date:
Security Code:
Name on Card and Billing Address:
Which Classes are you registering for? Please include CLASS NAME, DAY, TIME, AGES & TEACHER. Example: Ballet/Tap Wednesday 4:30 Ages 3-4 Miss Katie (See "Tentative Schedule Tab" for days and times):
How did you hear about us? (If by a student already enrolled please tell us who):
Questions or Comments?

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