Rosedale Valley Dance Registration

Rosedale Valley Dance Registration

2025 / 2026 Season
Birth Date

MonthDayYear
Date
Student Name

First NameLast Name
Age of Student (as of Dec 31, 2025)
Grade
Parent / Guardian (1)

First NameLast Name
Parent / Guardian (2)

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Number - Parent / Guardian (1)

Area CodePhone Number
Phone Number - Parent / Guardian (2)

Area CodePhone Number
Email Address - Parent / Guardian (1)
example@example.com
Email Address - Parent / Guardian (2)
example@example.com
*Please Note Any Learning or Physical Disabilities:
Please Note if this is your child's 5th, 10th or 15th year with our studio
Years of Dance Experience
Interested in Extra Projects? (for dancers with 5+ years experience / teachers decision)

Other
Types of Dance Student Wishes To Take This Year
I, First Name* Last Name* (Parent / Guardian) hereby give my consent to allow pictures of my child First Name* Last Name* (dancer's name) to be displayed as part of our studio's promotion (i.e. Website, in studio, recital displays, etc.)
Signature
Signature Date

MonthDayYear
Date
REGISTRATION FEE: $35 payable to Rosedale Valley Dance at time of registration.
Additional dancers in same family pay $15 each.
NOTE:

Costume fees must be paid separately to the studio
Should be Empty: