Dance Registration
Student Registration and Consent Form
Parent Name
*
First Name
Last Name
Parent Name
First Name
Last Name
Primary Phone Number
*
Format: (000) 000-0000.
Emergency Phone Number
*
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Dancer Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Dancer Interests (ballet, hip hop, jazz, etc).
Dancer Favorite Song(s)
Allergies if any:
List anything else the studio should know.
Please check all to register:
I am aware that the $100 tuition is non refundable.
Dancer will be on time, if not, I understand no make up class is available.
I consent photos and videos of student(s) may be used for marketing purposes only on Instagram, Facebook, and or website.
I understand there is a $100 tuition fee to register dancer/student in Summer Dance Camp 2026
*
Agree
Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: