2023-2024 Dance Season Registration Form

Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Student Gender *

Female

Male

Non-Binary

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Additional Parent/Guardian

First Name

Last Name

Phone

(###)

###

####

Student Primary Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Emergency Contact *

Parent/Guardian would always be contacted first

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Payment Plan *

Please select a payment plan option below: Monthy: Payment due by studen'ts first class of the month. 9 Monthly Payments. Annual: Full season's payment due in full by first class of the season (September). 5% Discount.

Monthly

Annual