Registration
1 openings left in this event!
Already a customer? Click here to login.
Enjoy the beauty of ballet and relieve some stress with a ballet barre, floor stretches, and center exercises. We'll emphasize the use of breath in creating movement and work on grace, poise, balance, strength and confidence in a relaxed and encouraging environment. $25 per drop-in
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Father
Guardian
Mother
Other
Parent
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non-binary
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Training:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non-binary
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Training:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non-binary
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Training:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non-binary
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Training:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non-binary
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Training:
*
Questions/Options:
How did you hear of RCDA's adult classes?
Additional Information:
Payment Information
(Show-Hide Details)
I give Rock Creek Dance Academy permission to charge my credit card for the cost of this class as follows: $25 per 60-minute class drop-in, to be charged upon my arrival for class.
I've read the above and agree.
Release of Liability
(Show-Hide Details)
While attending events at Rock Creek Dance Academy (RCDA), there is always the possibility of injury. RCDA will provide responsible care, but if some injury should occur, I agree to release and hold harmless Rock Creek Dance Academy, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Rock Creek Dance Academy, its owners and operators or in route to or from any of said premises.
I've read the above and agree.
Medical Emergency
(Show-Hide Details)
The undersigned gives permission to Rock Creek Dance Academy, its owners and operators to seek medical treatment for the participant if necessary. I hereby declare any physical/mental problems, restrictions, or conditions in the Comments field below and/or declare the participant to be in good physical and mental health.
I've read the above and agree.
Video and Photo Release
(Show-Hide Details)
I give Rock Creek Dance Academy my permission for the public display of photographs and/or videos of myself for possible marketing/advertisement purposes (i.e. brochures, newspaper ads, facebook, website, etc. - no names will be used).
I've read the above and agree.
Cancellations
(Show-Hide Details)
If Rock Creek Academy is not able to offer this adult class as planned, I understand that I will be notified promptly and will not be charged for the class. If I am unable to attend a class for which I registered in advance, I will email Christina Prete to cancel my registration.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
Please Wait...