Summer 2026 Registration

Summer 2026

Registration Due by May 18th
Student Name

First NameLast Name
Age at time of registration
Date of Birth

MonthDayYear
Date
Parent Name (if under 18)

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Which Session or Intensive would you like to register for?
If more than one please select all that apply.
4 Week June 1-27 Session Options
If more than one please select all that apply. June 1st-27th
6 Week July 5-August 15 Session Options
If more than one please select all that apply. July 5th - August 15th
For classes that meet twice a week, please specify if you plan to attend both or one day per week. Any additional comments or questions can be left here:
Please tell us about any allergies, medical, or special circumstances we may need to know about.
Waiver of Liability: By submitting this form I agree to the following waiver of liability.

I acknowledge the risk in physical activity during dance, fitness, and movement classes and release Dirigo Conservatory of Movement from all liability of injury that may occur while participating in said risk.
Payment is due prior to the first class and can be made in the form of cash, check to Dirigo Consveratory of Movement, or Venmo @Morgan-Sanborn.
Should be Empty: