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Dance Extension: After School Dance Program Registration Form 2019-2020
Upon completion of this form you will be emailed a confirmation, initial bill, and schedule for your student's enrollment. If you have not received a confirmation within 72hrs please email:
dancesextensionllc@gmail.com
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* Indicates required question
CLASS OPTIONS
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Check all class you would like to join. All classes must meet minimum enrollment numbers.
HIP HOP: Mondays: 3:30-5:00pm. (January 6th - May 9th) Taught by Decimus Yarbrough. This is a beginning/intermediate level class.
BALLET 1 & 2: Wednesdays 3:30-5:00pm. (January 10th - May 13th) Taught by: Sarah Fuhrman. This is an intermediate level class.
JAZZ 2: Thursdays 3:30-5:00pm. (January 9th - May 14th) Taught by: Mari Juras. This is an intermediate level class. Recommended for Dance 3 and Dance 4 level students.
Required
PAYMENT PLANS - Choose which payment plan you would like to sign up for. See descriptions below.
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TERM 2=18 WEEKS 1 Class: $45.50/MONTH, $252/TERM; 2 Classes: $100/MONTH, $504/TERM; 3 Classes: $145/MONTH, $696/TERM
PLAN A: MONTHLY (2 CLASSES) $100 Due the 15th of each month.
PLAN B: TERM (2 CLASSES) $504 Due January 15th.
PLAN C: MONTHLY (3 CLASSES) $145 Due the 15th of each month.
PLAN D: TERM (3 CLASSES) $696 Due January 15th.
PLAN E: MONTHLY (1 CLASS) $45.50 Due the 15th of each month
PLAN F: TERM (1 CLASS) $196 Due January 15th.
Student's first name
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Your answer
Student's last name
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Your answer
Student's Grade in School
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6th Grade
7th Grade
8th Grade
Other
Student's age
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Your answer
Student's Dance Level in School
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Dance 4
Dance 3
Dance 2
Dance 1
Other:
Student's full address, including city, state and zip code
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Your answer
Parents/Guardian name #1
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Who should we contact first in an emergency?
Your answer
Parent/Guardian #1 cell phone number
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Phone number for who we should contact in an emergency.
Your answer
Parent/Guardian #1 email
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Your answer
Parent/Guardian name #2
Who should we contact second in an emergency?
Your answer
Parent/Guardian #2 cell phone number
Phone number for who we should contact second in an emergency?
Your answer
Parent/Guardian #2 email
Your answer
Student cell phone number, if applicable
*
If no cell phone, enter no cell in the answer field.
Your answer
Emergency contact name & phone number
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In the event of an emergency, if we are unable to reach parents or guardians listed in the previous fields, who should be contact?
Your answer
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