September Dance Registration Form 2025/2026

Dance Registration Form

September 2025 - June 2026
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Age as of Sept 1, 2025*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Any medical conditions or allergies we need to be aware of*
Parent/guardians name if under 18 years

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Emergency contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.

I have summited a credit card in the past and would like this to be used for future payments

YesNo, you will be contacted to fill out a form

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty: