Registration

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For our newest competition dancers looking forward to taking their skills to the next level, this program offers instruction each day in jazz, tap, ballet hip hop, and acro. Dancers will quickly expand their technique and terminology in this high energy camp. Please pack all dance shoes, a water bottle, and a healthy snack.

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*

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

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Additional Information:

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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: