Movement Dance Studio Registration Form

Movement Dance Studio Registration Form
Student Name

First NameLast Name
Birth Date

MonthDayYear
Parent Name

First NameLast Name
Parent E-mail
example@example.com
Parent Phone Number
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Number of Classes*

1234Unlimited
*Please refer to the 2023-2024 schedule to choose classes. This table is set up this way for simplicity, so not all classes are available on all days.

Select Classes*

	M	T	W	Th	F	Sat
Tap
Jazz
Gymnastics
Hip Hop
Ballet
Contemporary
Pointe
Musical Theater
Creative Movement
Ballet/Tap (combo class)
Hip-Hop/Gym (combo class)
Ballet/Contemporary (combo class)

Additional Comments Regarding Class Selection
If you are registering multiple dancers, please only submit a payment on one dancer's registration form.

Please Select Registration Type

Single Dancer Registration

$20.00

Family Registration

$25.00

Total

$0.00