bellAdance Summer New Customer Registration Form 2026

Today's Date

Date

New or Returning Student

Contact and billing information:

Parent #1 Name

First NameLast Name

Parent #1 Number

Format: (000) 000-0000.

Parent #2 Name

First NameLast Name

Parent #2 Number

Format: (000) 000-0000.

Primary E-mail

Email is our #1 form of communication!!

Secondary E-mail

Email is our #1 form of communication, please include if you'd like a second email address to receive notices.

Address

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Format: (000) 000-0000.

Students Full Name

First NameLast Name

Students' Birthday

Date

Age

Current Academic School (for of fall 2025-26)

Allergies or Medical Conditions we should be aware of

Years of Dance Training

Where have you trained?

How did you hear about bellA dance?

Please review the schedule and indicate below the class you would like to register your student for. bellA dance teachers will review this form and your request and contact you regarding correct class placement prior to verifying your placement.

Class Selection- (Please select all classes you would like to register for. You can select multiple classes by holding down CONTROL while clicking the class)

Total Number of weekly class hours

Additional notes regarding class selection

Do you have additional students to register?

Additional Students Full Name

First NameLast Name

Additional Students' Birthday

Date

Age

Additional Students' Current Academic School

Allergies or Medical Conditions we should be aware of

Years of Dance Training

Where have you trained?

Class Selection- 2nd child (Please select all classes you would like to register for. You can select multiple classes by holding down CONTROL while clicking the class)

Additional notes regarding class selection

Total Number of weekly class hours for Additional Student

Total number of combined class hours

Class Etiquette/Dress Code Agreement

Date

Printed Name

Signature

Payment:

Single Student Registration Fee (Required for all students who didn't attend class for 2025-26 school year)$30.00

Additional Student$20.00

Additional Student 2$20.00

Additional Student 3$20.00

Total $0.00

Credit Card

You will receive an email from bellA dance confirming your registration and class placement. This email will have your 6 week tuition invoice attached to it with the option to submit an electronic payment.

Summer 2026 Registration Form

Contact and billing information:

Payment:

Credit Card