DPDC Student Registration

Dance Class Registration Form

2025-2026
Student Info
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age
Grade
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New or Returning Student?*

Returning StudentNew Student
Any health conditions?

YesNo
If yes, please name
Desired Classes
Parent/Guardian Info
Name*

First NameLast Name
e-mail*
Cell Phone

Area CodePhone Number
Relationship to Student*
Emergency Contact
Name*

First NameLast Name
Relationship to Student*
Cell Phone

Area CodePhone Number
Safety Procedures
Drop off Program

The studio is restricted to dancers and staff only due to limited space in the lobby and to minimize traffic follow.Parents are to remain outside unless directed by staff that they are needed by their child.Please do not send you child to class if you, your child or any household family member has been sick with a fever over 100.4F, vomiting more than twice in 24 hours, diarrhea, sore throat, chills , signs of weakness and tiredness(not associated with dance).
I have read the above safety and drop off rules*

I Agree
Terms and Conditions
By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), agree to release Danielle Peyton Dance Company including instructors and assistants from liability for any and all injuries which may occur while training, practicing, performing, or during any studio event or activity.

You also agree that you are responsible for health and accident insurance and any medical costs incurred due to injury. You give permission for emergency medical transportation and treatment of your student(s) at your expense should the need arise.

You also give your permission for the public display of any studio visual images that your child may appear in.
please select*

I Agree
Today's Date

MonthDayYear
Date
Payment
Your spot will not be reserved until payment is submitted.

You can pay using venmo user id DPDANCE last four cell phone 0334
Should be Empty:

Dance Class Registration Form

Student Info

Parent/Guardian Info

Emergency Contact

Safety Procedures

Terms and Conditions

Payment