Summer Registration Form

Address *

Date of Birth *
Age *
Phone Number *

Area Code Phone Number
Email *
example@example.com
Years of Dance Experience *
Any Medical Conditions, Allergies or Special Needs that we should be aware of *
Classes Enrolling in *
How did you hear of us?
Parent or Guardian Information (If Applicable):
Name

First Name Last Name
Phone Number

Area Code Phone Number
Email
example@example.com
Emergency Contact (If Different than Parent or Guardian Information)
Name

First Name Last Name
Phone Number

Area Code Phone Number
Email
example@example.com
Tuition is due at the beginning of each class.
All Tuition information and Policies are listed on our website.

For public relation purposes photos and videos may be taken of you or your child. If you object to the use of these photos or videos you must notify Contemporary Academy of Dance in writing.
Liability Release
Contemporary Academy of Dance is not liable for any injury, damage or loss of property. I release Contemporary Academy of Dance from all liability, injury, damage or loss of property. I have read and agree to the payment terms, fees, and policies listed on our website.
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Registration Form