registration

Registration

Please send us your information by filling out the form below.
If you prefer to send us a fax or a hard copy by regular mail, click here to download a PDF file.
Please complete the form below and note, you will not be billed until one of our staff members contacts you to confirm your registration.

Registration Form

Student's Name: *

First

Last

Date of Birth Month: *

Day *

Year *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent's Name: *

First

Last

Home Phone Number: *

Cell Phone Number: *

Work Phone Number *

Email *

List all prior dance training & any training you are currently receiving elsewhere (where, when, how long, style, etc.): *

List the classes you wish to enroll in: *

“I recognize that dance does involve a risk of harm or injury, therefore, I agree to hold Dance Arts Academy, its teachers and representatives, harmless from any injury I/my child may incur during my/my child’s training here. I have read and agree to abide by the policies, procedures, & dress code of Dance Arts Academy.” *

Agree Disagree