Registration
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Encampo Ballet, Jazz & Acro Ages 3-5
July 10th-14th, 2023 9:00 am - 12:00 pm
Studio 3 | Limit 12 Students

Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
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Family Information
First Name:* Last Name: *
Relationship to student*
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:
I understand there are no refunds after May 1. Class may be changed if program is available.*
I uunderstand there will be a $5.00 charge per minute I am late picking up my child. *
I understand drop off and pick up will be done in the dance hallway not in the circle *
I understand this is a week long program*
 
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:*