Registration
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2021/22 JUNIOR & TEEN COMPANY Audition (11-13)
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
 
Questions/Options:
Where have you studied dance?*
How long have you studied each genre: Ballet, Jazz, Contemporary, Hip Hop, Tap?*
 
Additional Information:
 
COVID 19 Waiver
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I've read the above and agree.
 
Liability Waiver
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I've read the above and agree.
 
Payment Agreement / Policies
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I've read the above and agree.
 
Photography / Video Waiver
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I've read the above and agree.
 
Enter your Full Name: *   
 
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:*