This constitutes the agreement between student/responsible party and Pirouette Dance Academy for all classes and/or activities the student is pursuing at or with Pirouette Dance Academy. I authorize Pirouette Dance Academy, Inc. to charge the agreed amount listed to my credit card provided herein. I agree that I will pay for this registration in accordance with the issuing bank cardholder agreement.

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Referral Information
Family Information
Where do you live?
Additional Info
Contact #1
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Portal Access (your email is your login)
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Contact #2
How can we contact you?
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Student #1
Additional Info
Required Policies
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Questions or Concerns
Payment Information
Credit Card
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