Diversity Dance Summer Registration 2021
June & July
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Email *
*
Email Address *
Student Name *
Student Birth Date *
MM
/
DD
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School *
Grade *
Parent/Guardian Name *
Guardian Cell Phone Number *
In the event you are unable to reach me, in the case of accident or injury, I give my permission for treatment as deemed necessary by staff or emergency personnel. I also release Diversity Dance Studio and its staff of liability in case of injury or accident incurred to my child. *
Summer Weeks 1-7 Pricing:
Dress Up and Dance Camp: $65
Level 1 & 2 intensives: $165
Level 3 & 4 intensives: $210

Class Punch Card for Evening Classes during Weeks 3-5

12 classes- $192
10 classes- $160
8 classes- $128
6 classes- $96
4 classes- $64
2 classes- $32
Drop in Rate- $20 per class

How will you be paying for Summer Classes? *
Please check the boxes below of all that you would like to enroll your dancer in for Summer Weeks 1-7
Week 1: June 7-10
Week 2: June 14-17
Week 3: June 28- July 1
Week 4: July 5-8
Week 5: July 12-15
Week 6: July 19-22
Week 7: July 26-29
A copy of your responses will be emailed to the address you provided.
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