Summer Intensive Registration Form

Please fill out the form below to register.

Dancer Name*
First Last
Dancer Birthdate*
Parent/Guardian Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
List any Health or Medical conditions the studio should be aware of:
Summer Intensive Tuition*
- Beginning/Intermediate $175
- Intermediate/Advanced $175
Coupon
Total
$0.00
Credit Card
Card Details
Cardholder Name
Please read and agree to the following:*
- I understand that there will be NO CREDIT given for any deposits or tuition paid. ALL TUITION IS NON-REFUNDABLE.
- I grant permission to A Time To Dance, the use of photographs and/or video of my child to promote dance and/or the dance studio.
- All students and the parents/legal guardian are aware of possible physical injury that may occur during dance/gymnastics classes, performances and/or rehearsals and are willing to assume those risks. It is agreed that A Time to Dance, it’s officers, directors and associates are NOT RESPONSIBLE FOR PERSONAL INJURY OR PROPERTY LOSS.
Signature Required*
Notes: Anything else we might need to know.