Registration Form

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Registration Form

Welcome to Melina's Dance Company! Please complete all fields to finalize your registration.

Registration fees are due within 7 days of registration to secure your spot.

Please complete the form below to complete your registration for dance classes.

If you are new to our studio, after completing this form a team member will send you a separate email with you parent portal log-in information. Your parent portal will give you access to add a credit card to your file and access important information about your dancer's classes. The email may take 24-48 hours.

Don't forget to check our evening summer dance program at www.melinasdance.com/summerdance

Email *

Student First and Last Name *

Dancer's Gender *

Female

Male

Prefer not to say

Required

Student Date of Birth *

YYYY

Parent/Guardian Name *

Home Address *

Please include street address including postal code

Phone Number 1 *

Phone Number 2

Email address *

Please provide a valid email address. This is where you will receive all studio communication.

Additional Contact Details

Emergency Contact Details

If different to details listed above

Please list any medical conditions, allergies or additional needs.

Military or First responder family *

Yes

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