Registration

The Debbie Allen Dance Academy currently houses five dance programs:

Academy Levels I II, III, & IV, a comprehensive dance curriculum for the committed student.

Red Bird and Conservatory, rigorous ballet and modern focused training programs for the dedicated student

Sons of DADA, a scholarship program for young male dancers, 8 years and up.

July 11, 12pm

and

August 22, 3pm

Our dancers study Ballet, Contemporary, Dunham, Flamenco, Hip Hop, Jazz, African, Latin Fusion, Modern, and Tap.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info (Not Contact #1 or #2)*

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	Student Email:
	School:	Grade Level:*
	Allergies:
	Medications:
	Primary Doctor:*
	How do you Identify Ethnically:

Additional Information:

Other Questions/Comments:

Credit Card Verification:

Card Number: *

Name as it appears on card: *

Nickname:

Card Expiration Month: *

Exp Year: *

Address Line 1:

Address Line 2:

City:

State: Zip:*

eCheck/Bank Draft:

Bank Name:

Bank Routing Number:

(9-digit number)

Your Account Name:

(Your name on your bank statement)

Your Account Type:

Account Number: