Registration Form
Please fill out this form in its entirety
Student's Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School
Dismissal
Grade Level
Current Medications and/or Food Allergies
*
Please type "none" if not valid
Parent Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Parent Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Mother's Place of Employment
Father's Place of Employment
Any previous dance training?
*
Please Select
Yes
No
If Yes, how long and what type?
How did you hear about Carolina Dance Arts?
Siblings to student. Please provide Name, Gender, and Age
Tuition
Student's full monthly tuition is due on the 1st day of each month, no later than the 5th.
Monthly Tuition
*
Please Select
1 weekly class: $80
2 weekly classes: $140
3 weekly classes: $160
4 weekly classes: $180
Unlimited: $245
Summer Camp: Contact Office
Please select a class option
Annual Registration Fee
*
Please Select
$45 per student
$65 per family (siblings)
Summer Camp: Contact Office
Total Cost
Class Registration
Terms and Conditions
*
I agree to allow Carolina Dance Arts to use photos/videos of my child for marketing and advertising materials including social media, website, and printed material.
*
Yes
No
I agree to the terms of everything on this form. Name of the signatory.
*
First Name
Last Name
Additional Emergency Contacts
Please provide 2 additional emergency contacts
Name
*
First Name
Last Name
Relation to Student
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name
*
First Name
Last Name
Relation to Student
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Submit
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