Enrollment Application If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. Student's Name * Birthdate * Age * School * Grade * Parents' Name * Address * City, Zip Primary (Home or Cell) Phone Number * Work Phone Other Phone eMail Address * Contact Preference * Text email Account Billing Name * May we use your child's photograph in promotional literature and our website? Classes Desired * FUNdamentals of Dance I - 4 yrs oldFUNdamentals of Dance II - Ages 5 and 6BalletPrepointeJazzModernDanspiration For New Students Only: Previous dance training (years/classes) Previous Teacher(s) Name(s) Name of previous dance studio(s) & location(s) How did you learn about the studio? Are other family members enrolled? YesNo Their Name(s) I/We have read and understand the Studio's Policies and hereby agree to fully abide by these policies. Date * *** Please ensure that all required information is provided! *** ***If you do not receive a very clear and obvious "success" message after submitting the form, a required field was not completed! *** Registration form must be submitted before student may attend class. If you are a human and are seeing this field, please leave it blank.