Online Dance Class Registration Form
2026 Mini Session Dance Schedule
5 Week Mini Session
Thursdays
Jan. 8 - Feb. 7
12:00 PM - 12:45 PM
Student Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Age
*
Gender
Male
Female
Do you want to add enroll more students?
Yes
No
Additional students
Parent/Guardian Information
For minors (below 18 years of age)
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Relationship
*
Miscellaneous
How do you learn about this online dance class?
Facebook
Instagram
Referral
Other
Choose Class
*
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Pre-ballet Mini-Session
$
49.00
Quantity
1
2
Item subtotal:
$
0.00
Enter coupon
Apply
Total
$
0.00
Payment & Confirmation
Payment Method
*
PayPal
Other
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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