Dance Class Registration

Student Name*

First NameLast Name

Date of birth*

Date

Gender*

MaleFemale

Parent/Guardian Name *

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Name*

First NameLast Name

Relationship to Student*

Dance Style*

Mini Class 3yrs-5yrs (Saturdays 9am-10am) BAREFOOT OR PINK BALLET SHOES BLACK LEGGINGS AND BLACK SHIRT OR LEOTARD AND TIGHTS, HAIR OUT OF FACEBallet/Jazz 11yrs-17yrs (Saturdays 11:15am-12pm) BAREFOOT OR BLACK JAZZ SHOES BLACK LEGGINGS AND BLACK SHIRT OR LEOTARD AND TIGHTS, HAIR OUT OF FACEBallet/Jazz Combo 6yrs-11yrs (Saturdays 12:10pm-1:10pm) BAREFOOT OR PINK BALLET SHOES BLACK LEGGINGS AND BLACK SHIRT OR LEOTARD AND TIGHTS, HAIR OUT OF FACEHip Hop 11yrs-17yrs (Saturdays 1:15pm-2pm) SNEAKERS OF YOUR CHOICE BLACK LEGGINGS AND BLACK SHIRT OR TANK, HAIR OUT OF FACELiturgical 9yrs-17yrs (Saturdays 2:10pm-3:10pm) BAREFOOT OR BLACK JAZZ SHOES BLACK LEGGINGS AND BLACK SHIRT, HAIR OUT OF FACE

Phone Number*

Please enter a valid phone number.

Dance Style*

Mini Class 2yrs-5yrs (Saturdays 9am-10am)Ballet/Jazz Combo 6yrs-11yrs (Saturdays 12:10pm-1:10pm)Ballet/Jazz 11yrs-17yrs (Saturdays 11:15am-12pm)Hip Hop 11yrs-17yrs (Saturdays 1:15pm-2pm)Liturgical 9yrs-17yrs (Saturdays 2:10pm-3:10pm)

Dance Style*

Mini Class 2yrs-5yrs (Saturdays 9am-10am)Ballet/Jazz Combo 6yrs-11yrs (Saturdays 12:10pm-1:10pm)Ballet/Jazz 11yrs-17yrs (Saturdays 11:15am-12pm)Hip Hop 11yrs-17yrs (Saturdays 1:15pm-2pm)Liturgical 9yrs-17yrs (Saturdays 2:10pm-3:10pm)

Medical Conditions or Allergies (N/A if none)*

Terms and Conditions:

By submitting this form, I acknowledge that participation in dance classes involves physical activity and I hereby release Dance LYFE and its instructors from any liability for injuries or accidents that may occur during classes or events.

My Products*

Monthly Dance Class Payment methods will be charged each month. Note the 1st month includes a $20 registration fee. Classes are held once a week on Saturdays.

$120.00 for the first payment then,$100.00 for each month

Monthly Dance 2 Classes Payment methods will be charged each month. Note the 1st month includes a $20 registration fee. Both classes are held once a week and on Saturdays. (This is for a student who will take two different classes on Saturday i.e. Ballet/Jazz AND Hip hop please note Ballet/Jazz is all in one class.)

$185.00 for the first payment then,$165.00 for each month

Monthly Dance 3 Classes Payment methods will be charged each month. Note the 1st month includes a $20 registration fee. All three classes are held once a week and on Saturdays. (This is for a student who will take three different classes on Saturday i.e. Ballet/Jazz Hip hop, AND Liturgical please note Ballet/Jazz is all in one class.)

$225.00 for the first payment then,$205.00 for each month

Drop-In 1 Class per month Method of Payment will be charged each month. Drop-ins are for ONLY 1 class per month any style. Please note there is a $20 registration fee included in the first month's payment. THE COUPON CODE IS INVALID FOR THIS SUBSCRIPTION.

$55.00 for the first payment then,$35.00 for each month

Enter coupon

Total

$0.00

Credit Card

Signature*

Date signed*

Date

Child Dance Registration Form

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