~ 2012- Online Registration Form ~
82 DanceArt Drive.
Garner, NC 27529
919-550-6556

Note:(We offer FREE online Registration and we will contact you for your credit card/payment information. We will still need the following information to register online. This form is hosted on a secure server and your information will not be transferred or seen by anyone but the owner of DanceArt. If you have any questions, please contact us.

I am Registering My Child for: (Please choose one or more of the following)

Feb-May Semester 2012 Summer 2012

Student Information:

Student’s Last name: First Name

Grade for 2011-2012 School Yr Age

Date of Birth Sibling Enrolled? Yes No

Medical Concerns/Allergies/Disabilities/Other:

Parent’s Email

Other Email (Please print clearly)
(EMAIL ADDRESS IS VERY IMPORTANT)

Name: Home Phone:

Mailing Address:

City: Zip:

Work Phone: Cell Phone:

I grant permission to DanceArt the use of all photograph and
video footages taken of me and/or my child for program & advertising purposes.

Yes No

Please include the class day and time that you prefer:

Class your prefer: (hold control, then click to select multiple options)

Mommy & Me Pre Ballet Ballet Tap/Ballet Combo Jazz Hip Hop Clogging Lyrical Praise & Worship Pointe Tap Adult Classes Unsure for now.

Time you prefer: (hold control, then click to select multiple options)

Morning (9:30am-12:00) Early Afternoon (1-3:30pm) After School (4:00-6:00) Evening (After 6:00pm) Unsure for now

Day/Time for Class #1

Day/Time for Class #2
(+$30 more a month for the 2nd class a week)

Please list a second option: Class Day/Time
(the 1st choice may be full)

Please list “Dance Experience” for level placement:

No dance experience

# Years of Dance Experience

Studio Name

How did you hear about us? Please check as many that apply:

Coupon Magazine in mail
Postcard
Friend
Passed by facility
Current student - Current student’s name
Other

Emergency Contact other than parent/guardian:

Name Phone

Please check one:

Yes - DanceArt Studio has an end of year performance in May. If your child chooses to participate in the performance, you will have to purchase a $50-$55 costume in November that will be ordered by DanceArt Studio. You will have to purchase tickets to the show.

No - My child will not be able to participate

You are not locked into a contract! (Students can drop at anytime-notify a staff member and your child will no longer be enrolled.)

In order to complete and email this form correctly, please click the submit button below! ( Only Parents or Personal responsible for payment please fill out the form. No children please.)