Registration Form

Mailing Address
City/State:    Zip

Home:  Cell

In case of emergency call:
Name:

Phone:

Cell:

List Dance Training:
Studied: (circle) ballet, pointe, jazz, tap, hip hop, other:
Where: Number of years:
List any physical limitations:
Injuries:
How did you hear about us? (please check)
Website Friend Driving By Phone Book Newspaper Other:

Class space is reserved. Therefore no refunds or credits can be given for missed or dropped classes . Registration fee, deposits or tuition will not be refunded.

The parent or adult student signing this release acknowledges our policy as stated on the tuition form and understands that his/her child or adult student is taking classes at his/her own risk and agrees to hold Civic Dance Center. its instructors, and/or assignees harmless in the event of any physical injury to the student. Person signing this form is responsible for payment of registration fee, and/or tuition. Registration Fee is $25.00 (New Students) $20.00 (Returning Students) $30.00 Per Family (New/And or returning students). Please enclose with registration form.
Tuition enclosed: $ or deposit of $ is enclosed.
Check # 

X                          X
Date Today                             Parent or Guardian Signature / Adult Student Signature