Registration


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.

*   denotes required fields

Referral Information
Family Information
Where do you live?
Additional Info
Contact #1
How Can We Contact You?
Portal Access (your email is your login)
(Emails are kept confidential)
Contact #2
How can we contact you?
(Emails are kept confidential)
Student #1
(format=mm/dd/yyyy)
Additional Info
Required Policies and Agreements
I Agree to All of the Above
Questions or Concerns
Payment Information
Credit Card