Registration Form

Name *
Name
Date of birth
Date of birth
Phone *
Phone
Best way to contact you
Parent Name *
Parent Name
Address *
Address
Are you a returning student?
Previous Dance Experience?
If answered yes, please explain.
We would love to hear how you heard about us!
Please list any health condition that we need to be made aware of, ie. asthma, past injury, etc.
For sponsorship reasons only.
Classes
Monday Classes
These classes are available on Monday at Dominion Arts Center
Tuesday Classes
These are the classes available on Tuesday at The Glen Allen Cultural Arts Center.
Wednesday Classes
These classes are available on Wednesdays at Glen Allen Cultural Arts Center.
Thursday Classes
These classes are available on Thursdays at Dominion Arts Center.
Other Important Information
Emergency Contact *
Emergency Contact
Emergency Contact Information *
Emergency Contact Information
Date of Payment
Date of Payment
$