Your Name
*
First Name
Last Name
Child's Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Any allergies or medical conditions we should know about?
Which class(es) would you like to register for?
*
Ages 12-18 Monday 6:30-7:30 Ballet
Ages 12-18 Monday 7:30-8:00 Hip Hop
Please read and check off the following:
I acknowledge and understand that there will be monthly automatic drafts debited on the 15th of each month from now until the month of May, unless I proactively call and cancel this arrangement.
I understand that I am required to either visit the front desk or call to provide my payment method information, and I hereby authorize the organization to automatically debit my account each month for the designated payments.
I am aware that in addition to my monthly tuition, there is a $395-495 performance fee, which can either be spread out over the year or paid in full by November. If my child chooses not to participate in the performance, they can continue attending classes through December and then enroll in mini sessions.
I hereby grant permission for the use of my child's likeness and image on social media and marketing materials for promotional purposes related to the program or organization.
My Products
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Dance Year Registration Fee
$50.00
$
50.00
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