Summer Registration Form

Registration Form

Summer Classes
Dancer’s Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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. Payments can be made by cash or checks, make checks payable to Contemporary Academy of Dance.
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.
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

Registration Form