Clone of 2025 Fall Class Registration

2026 Summer Dance Registration
HIP HOP

Instructor: Chandler Nicholson
Hip Hop starts June 8
6 week term
Break week of June 29
$75
$5 sibling discount

Wear dance shoes or close-toed sneakers. No dress code.

BALLET/TAP/MUSICAL THEATRE DANCE

Instructor: Tala Gvozdas
Starts June 1
6 week term
$75 first class/one term
$25ea add’l class

Ballet class: Ballet shoes, any color
Tap class: Tap shoes, any color, any style
Musical Theater Dance: Ballet or Jazz shoes, or close-toed sneakers
No dress code.
Adult/Parent/Guardian Info

Fill this section out if you are an adult participant
Name

First NameLast Name
e-mail
example@example.com
Primary Phone
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact
Relationship to Student
Emergency Phone
Format: (000) 000-0000.
Billing Info
Please note: Parent/Guardian listed above assumes primary responsibility for account maintenance. Billing Info is for contact information only.
Billing Name

First NameLast Name
e-mail
example@example.com
Primary Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Info
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Age
Student Cell Phone
Format: (000) 000-0000.
1 - Hip Hop
1 - Ballet
1 - Tap
1 - Musical Theatre Dance
1 Tala Total
1 Multi-Class Discount
1 Total
Add Student 2?
Student 2 Info
Student 2 Name

First NameLast Name
2 Date of Birth

MonthDayYear
2 Age
Student 2 Cell Phone
Format: (000) 000-0000.
2 - Hip Hop
2 - Ballet
2 - Tap
2 - Musical Theatre Dance
2 Dance Total
2 Family Dance Discount
2 Tala Total
2 Multi-Class Discount
2 Total
Add Student 3?
Student 3 Info
Student 3 Name

First NameLast Name
3 Date of Birth

MonthDayYear
3 Age
Student 3 Cell Phone
Format: (000) 000-0000.
3 - Hip Hop
3 - Ballet
3 - Tap
3 - Musical Theatre Dance
3 Dance Total
3 Family Dance Discount
3 Tala Total
3 Multi-Class Discount
Total 3
Add Student 4?
Student 4 Info
Student 4 Name

First NameLast Name
4 Date of Birth

MonthDayYear
4 Age
Student 4 Cell Phone
Format: (000) 000-0000.
4 - Hip Hop
4 - Ballet
4 - Tap
4 - Musical Theater Dance
4 Dance Total
4 Family Dance Discount
4 Tala Total
4 Multi-Class Discount
Total 4
Notes:
Terms and Conditions
Today's Date

MonthDayYear
Date
By agreeing below and submitting this form, you, the Participant or Parent or Guardian of the above student(s), agree to release STAAR, including instructors and assistants, from liability for any and all injuries which may occur while rehearsing, practicing, performing, or during any STAAR 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 you or your student(s) at your expense should the need arise.
Photo Release: By participating in a STAAR event, I understand that STAAR has the right to photograph me/my child and use the photo and/or other digital reproduction of my/their physical likeness for advertising and/or publication processes, whether electronic, print, digital or electronic publishing via the Internet.
Totals
Family Dance Discount
Homeschool Multi-Class Discount
Total Tuition
Cash/Check Price
Card Price
Payment is due by first class. Class sizes limited. You may bring cash or checks to 103 N. 1st Street, Pulaski. Call to make sure someone is here to take payment.

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USDEnter CARD PRICE from above

Credit Card

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2026 Summer Dance Registration

Adult/Parent/Guardian Info

Billing Info

Student Info

Student 2 Info

Student 3 Info

Student 4 Info

Terms and Conditions

Totals

Square Check-out

Credit Card