Dance Lakewood Online Payment Form
Student(s) Name
*
Email for Receipt
example@example.com
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( X )
45 Minute Class
$
55.00
Intro to Ballet (Ages 3-4) and Ballet/Tap Combo (Ages 5-6)
60 Minute Class
$
60.00
1 - 60 minute class per week
2 - 60 Minute Classes
$
108.00
3 - 60 Minute Classes
$
144.00
4 - 60 Minute Classes
$
190.00
Unlimited Classes
$
206.00
Annual Registration Fee (Due in September)
$
20.00
Credit card processing fee
$
1.00
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Expiration Year
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