Fall Registration form 2010-2011

NEW - Online REGISTRATION using our SECURE website!
Just complete the form below and click "SUBMIT"

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DANCER'S NAME:

required

DANCER'S BIRTHDATE:

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PARENT'S NAME(S):

 A value is required.

STREET ADDRESS::

required

CITY:

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HOME PHONE:

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Parent's Cell Phone:

Dancer's Cell Phone:

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PARENT'S EMAIL:

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Dancer's Email:

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SELECT YOUR CLASSES: Use the drop down boxes to select your class(es).

 

Preschool 3-4 year old classes:
Tap, Ballet & Tumbling
required
 

Kindergarten/Experienced 4 year old classes:
Tap, Ballet & Jazz
 

1st / 2nd Grade classes:
Tap, Ballet & Jazz
Please select an item.
 

Level 1 (3rd / 4th Grade) classes:
Tap, Jazz and optional Ballet
Please select an item
 

Level 2 (5th - 7th Grade) classes:
Tap, Jazz and optional Ballet
Please select an item.
 

Level 3 (8th Grade & up) classes:
Tap, Jazz and optional Ballet
Please select an item.


Hip Hop:
 Please select an item.
 

Kick line:
Please select an item.
 

Pointe:
Please select an item.
 

POM Classes:
Please select an item.
 

ADULT Classes:
 Please select an item.
 


Dance for Special Needs Kids:
Please select an item.
 

ALL BOYS Hip Hop Class:
 Please select an item.
 

Stretch / Acro / Tricks & Turns:
Please select an item.
 

Performing Lines:
Please select an item.
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I waive all liability of The Dance Warehouse and it's staff for injury of any type incurred while participating in studio sanctioned events.
I have read and accept the above waiver.

YOUR NAME:

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AUTHORIZED BY:

 Please select an item.
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THE REGISTRATION FEE IS $25 PER STUDENT
(Class placement will only be held with paid registrations.)

PAYMENT INFORMATION

PAYMENT TYPE:

 Please select a valid item.

Credit Card Type:

 Please select an item. invalidinvalidinvalid
(NOt

Credit Card Number:

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Exp. Date:

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OPTION TO KEEP CREDIT CARD # ON FILE:
I authorize The Dance Warehouse to debit my credit card for my tuition
amount on the 5th of the month, September through May, 2010.
Please select an item.
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