Summer 2026

Summer 2026
Student Name

First NameLast Name
Date of Birth/Age
Parent Name

First NameLast Name
Email
Phone Number

Area CodePhone Number
Dance Class TYPE
Dance Class DATES
Dance Class TYPE
Dance Class DATES
Dance Class TYPE
Dance Class DATES
Registration Fee Required $25 single $35 family.

Venmo- @kimferretti512 (preferred)Applepay- (919)272-0650 (preferred)Check- Millpond DanceCashCard of file (current students)Card (will call with info/new student)
Payment in full at time of registration.
Payment in full 7 days prior to start date.
If paying by Venmo/Zelle/Check please put name of dancer in MEMO.

Registration fee is NON refundable.
No refunds for missed classes.

Please call (919)629-4596 or email kim@millponddancestudio.com for total.

Please filll out seperate forms for family members.
Date

MonthDayYear
Date
Signature
Should be Empty: