This form is to request a trial class for a dancer. No payment information is required. PDA staff will contact you to confirm the date and time of the requested class and answer any additional questions.
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Relation to Dancer*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State/Prov: * Postal Code: *
Emergency Contact Info*
Students entered below will be added to your family's account
What class is your dancer interested in trying?*
Additional Information:
Other Questions/Comments: