No Registration Fee Form

STUDENT REGISTRATION
Student's Name*

First NameLast Name
Student's Age
(Only Required for Under 18yrs of Age)
Student's Date of Birth

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Allergies/Special Needs
Parent/Guardian(s)*

First NameLast Name
Email*
example@example.com
Mobile Phone 1
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Parent/Guardian(s)

First NameLast Name
Email Address
example@example.com
Mobile Phone 2
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
If you are a first time student, how did you hear about us?
Predancers 1 (Wednesdays) – 1hrPredancers 2 (Saturdays) – 1hrTiny Dancers – 1hrMini Dancers – 1hrJunior Tap&Jazz – 1.5hrsJunior Ballet – 1hrJunior Hip Hop – 0.75hrJunior/Tween Musical Theater - 0.75hrTween Tap&Jazz – 1.5hrsTween Ballet – 1hrTween/Teen Hip Hop - 0.75hrTween/Teen Musical Theater - 0.75hrTeen Jazz (LVL1) – 1hrTeen Lyrical (LVL1) – 1hrTeen Tap (LVL1 & 2) – 0.75hrTeen Jazz (LVL2) – 1hrTeen Lyrical (LVL2) – 1hrPre-Pointe/Pointe – 1hrTechnique (13+) – 1.5hrsTeen/Adult Hip Hop (Adv) – 0.75hrAdult Tap (ADV.) – 0.5hrAdult Jazz (ADV.) – 1hrAdult Lyrical (ADV.) – 1hrAdult Tap (Beginner) – 1hrAdult Tap (Intermediate) - 1hrAdult Hip-Hop (Beginner) - 0.75hrPrivate Lesson (Solo)Private Lesson (Duet)Private Lesson (Trio)
I have read and signed the DMSD Waiver as well as Release from Liability form*

Clear
I have read and understand the DMSD policies*

Clear
As a thank you for joining us, your new student registration fee is on us!

Registration Fee: $25.00
Promotional Discount Applied: -$25.00
Your Registration Fee Today: $0.00
Should be Empty:

STUDENT REGISTRATION