Julie Lang Studio of Dance Registration Form  2023-2024
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Student Last Name
Student First Name
Email
Student Status
Student date of birth
MM
/
DD
/
YYYY
Student age
Street Address - Town - Zip Code
Parent/Guardian Name & Relationship
Home Phone
Cell Phone
Work Phone
Parent/ Guardian will be financially responsible for class fees and costume payments.
In case parent or guardian cannot be reached whom may we contact, and if necessary, release the child to:
Emergency Contact Name
Home Phone
Cell Phone
Work Phone
Are there any health issues with the dancer?
Clear selection
Explain health issue(s)
Dance class choices. Check all that apply:
Write your class choices, days and times.
Registration Fee is $35.00 per family and non-refundable

Julie Lang Studio of Dance reserves the right to use photographs and video of students for the purpose of advertising and promoting Julie Lang Studio of Dance. Students or parents who do not wish to comply with this policy must notify Julie Lang when they register.

Parent/Guardian Signature Below:

Submit
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