Fall Semester Registration Form

Fall Semester Dance Registration

Fill the registration form below to sign up for fall semester.
Student Name

First Name Last Name
Birth Date

Month Day Year
Date Date Picker Icon
Student Name

First Name Last Name
Birth Date

Month Day Year
Date Date Picker Icon
E-mail
Phone Number

Area Code Phone Number
Parent Name
Parent Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Class Title, Day and Time
Class Choice(s)

45 minute class ($155/semester) 1 hour class ($210/semester) 1.5 hour class ($250/semester) Monthly payment 45 minute class ($45/month) Monthly payment 1 hour class ($55/month) Monthly payment 1.5 hour class ($70/month) Drop In Class Card ($180/10 lessons)

Semester Payment

USD Class Tuition (add $15 individual or $25 family registration fee)

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

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