Class Registration

Student Full Name*

First NameLast Name

Student Date of Birth*

Date

Parent Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

E-mail*

example@example.com

How did you hear about us?*

What types of classes are you registering for?

How many hours of class are you registering for?

0-0.75 hours per week ($60/month)1-1.75 hours per week ($105/month)2-2.75 hours per week ($155/month)3-3.75 hours per week ($205/month)Unlimited classes per week ($255/month)

Are you a member of SWITCH Starlettes Dance Company?

YESNO

If not, are you interested in SWITCH Starlettes Dance Company?

YESNO