Register

REGISTRATION

NEW students only. Previous or current students please email Rachel to see if a new registration form is needed.

Primary Contact/Guardian Information

This is the adult who will receive class information and be contacted in the case of an emergency:

* Indicates required field

Primary Contact/Guardian Name *

First

Last

Relationship to Dancer *

Email Address *

Cell Phone Number *

Home Phone Number *

Second Guardian/Contact Information

Please provide information for a second adult who can be contacted if we can not reach the primary contact:

Second Contact Name *

First

Last

Relationship to Student *

Cell Phone Number *

If this person would like to receive email updates please submit the address below: *

Dancer Information

Name *

First

Last

Nickname/Goes By *

Birthdate *

Current Grade Level *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Physical Address (If Different from Mailing) *

Line 1

Line 2

City

State

Zip Code

Country

Dancer's Email Address (If applicable) *

Dancer's Cell Phone (if applicable) *

Gender *

Known allergies, medical conditions or physical and/or emotional concerns staff should be aware of? *

Payment Preferences

I prefer to pay with... *

Cash/Check with Paper Invoices Card/PayPal with Email Reminders

Submit