Registration Dance


    REGISTRATION FORM
    (Use separate form for each child)
    2023-2024
    Register Early!! All programs have limited enrollments and
    we do not want to cancel classes due to late enrollment.

    (Check all classes that apply)

    Dance Style

    Age Group

    Day

    Times

    Fee

    Check

    Hip Hop/Lyrical

    6-10

    Mon

    4:15-5:30

    $575

    Technique 1

    By Level

    Mon

    5:30-6:30

    $575

    Junior Company

    By Invitation

    Mon

    6:30–7:30

    $575

    Technique 2

    By Level

    Mon

    7:30 – 8:30

    $575

    Broadway 3

    By Level

    Tues

    5:00-6:00

    $575

    Acting 1

    8-12

    Tues

    4:00-5:00

    $575

    Hip Hop/Lyrical

    9-12

    Tues

    5:00-6:15

    $575

    Broadway 1

    8-12

    Tues

    6:15-7:15

    $575

    Broadway 2

    By Level

    Tues

    7:15-8:15

    $575

    Hip Hop/Lyrical

    12-14

    Wed

    4:30-5:45

    $575

    Acting 3

    By Level

    Wed

    3:15-4:15

    $575

    Ballet

    8-14

    Wed

    4:15-5:15

    $575

    Acting 2

    By Level

    Wed

    5:15-6:15

    $575

    Senior Company

    By Invitation

    Wed

    5:45-7:15

    $575

    Tap Jazz

    6-10

    Thurs

    4:15-5:15

    $575

    Hip Hop/Lyrical

    6-10

    Thurs

    5:15-6:30

    $575

    Adult Tap

    -

    Thurs

    6:30-7:30

    $575

    Modern/Ballet

    13+

    Thurs

    7:30-8:45

    $575

    HLTJ

    By Invitation

    Fri

    2:30-4:15

    $575

    Ballet/Tap

    4-7

    Fri

    4:15-5:15

    $575

    Tap/Jazz

    8-12

    Fri

    4:15–5:30

    $575

    Hip Hop/Lyrical

    13+

    Fri

    5:30–6:45

    $575

    Total Amount: $

    Child’s Name*:

    Date of Birth*:

    (Format:mm/dd/yyyy)

    Age Today*:

    Grade Today*:

    Gender*:

    BoyGirl

    Name of Primary Parent/Guardian*:

    Email Address*:

    Address of Primary Parent/Guardian*:

    Phone Nos. Primary Parent/Guardian*:

    Name of Other Parent/Guardian:

    Email Address:

    Release Statement*: I hereby release the Executive Director and all employees of YORKTOWN STAGE from all claims of liability for any damages, including COVID related illnesses or injuries which may be sustained while my child is in Dance Class. I hereby give permission for my child’s photograph to be used in Yorktown Stage’s Dance Company advertising and promotions.

    Signature of Parent / Guardian (print name)*:

    Date*:

    (Format:mm/dd/yyyy)

    Credit Card Information:

    Card Type*:

    Card Number*:

    Expire Month*:

    Expire Year*:

    Sec. Code*:

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