Student Registration Form, Fall Registration 2017 - 2018

Fill out the online form below, and click "submit". All information provided to us remains confidential!

Students should register prior to July 15, as space is limited. Students registering after the 15th will be accepted on a first come, first served basis.

Student name (required):

Date of Birth: Age:

Male: Female:

Address:

City:

State: Zipcode:

Phone (required): Cell Phone:

E-mail:

Name of Parents/Guardians:


Emergency contact:

Emergency phone:

Please all allergies, asthma or other physical restrictions:


Years of dance experience: Last year of dance instruction:

Previous Instruction: (Please list types of dance studied and number of years of study)

Ballet Years studied: Tap Years studied:
Jazz Years studied: Lyrical Years studied:
Modern Years studied: Hip-Hop Years studied:

Please choose your dance curriculum below: (check all that apply)

Ballet Tap
Jazz Lyrical
Modern * Hip-Hop

Please note that Lyrical and Modern are only available to ballet students with three years experience. Students enrolled in Lyrical and/or Modern must be enrolled in, and attending a ballet class. Students enrolled in Hip-Hop must be enrolled in, and attending a jazz class.

*Students must be 10 as of 31 December 2017!

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