Student Registration Form for Dance Studio

Performing Arts Outreach Summer Registration 2025

This program is open to students ages 8-18 (Grades 3rd-12th). The program runs from July 8, 2025 thru August 7, 2025. Classes are Tuesday and Thursday 5pm-7:30pm. The total cost is $75 per student for the 5 week program. Space is limited.
Parent/Guardian Info
Name*

First NameLast Name
e-mail*
Primary Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact (If Parent/Guardian cannot be reached)*
Relationship to Student*
Emergency Phone*

Area CodePhone Number
Student Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age
Grade in School 2025
Student email
Student Cell Phone

Area CodePhone Number
New or Returning Student?*

Returning StudentNew Student
Does the student have dance experience?*
If the student has dance experience, what type of dance classes have been taken?

AcroBroadwayContemporaryHip HopLyrical/ModernPointePomTap
Add Student 2?

Add Student 2
Student 2 Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Grade in School 2025
Student email
Student Cell Phone

Area CodePhone Number
New or Returning Student?*

Returning StudentNew Student
Does the student have dance experience?*
If the student has dance experience, what type of dance classes have been taken?

AcroBroadwayContemporaryHip HopLyrical/ModernPointePomTap
Add Student 3?

Add Student 3
3 Student Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Grade in School 2025
Student email
Student Cell Phone

Area CodePhone Number
New or Returning Student?*

Returning StudentNew Student
Does the student have dance experience?*
If the student has dance experience, what type of dance classes have been taken?

AcroBroadwayContemporaryHip HopLyrical/ModernPointePomTap
We will make any necessary corrections and bill your account. Payment and a current account is required to secure a place in the summer program. Space is limited.
Notes:
Registration Fee*
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Young Debs Inc Performing Arts Outreach Program Registration Fee$75.00
The $75 fee per student covers the full 5-week program. This fee is non-refundable, will not be prorated, and applies regardless of late registration or early withdrawal from the program.

Quantity

Total $0.00
Terms and Conditions
Today's Date

MonthDayYear
Date
By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), agree to release "Young Debs Inc", 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.
I Agree

Payment Methods

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Choose from one of the PayPal options to make your payment.

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Performing Arts Outreach Summer Registration 2025

Parent/Guardian Info

Student Info

Student 2 Info

3 Student Info

Terms and Conditions