Registration Dance


REGISTRATION FORM
(Use separate form for each child)
2018-2019
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
Ballet/Tap 1
-
Mon
4:15 – 5:00
$485
Ballet/Tap II
-
Mon
5:00 – 6:00
$485
Ballet/Tap III
-
Mon
6:00 – 7:00
$485
Tap/Jazz I
-
Mon
7:00 – 8:00
$485
Advanced
-
Mon
8:00 – 10:00
$485
Tumbling
-
Tues
4:00 – 5:00
$485
Hip Hop/Lyrical II
-
Tues
5:00 – 6:15
$485
Broadway I
8-12
Tues
6:15 – 7:15
$485
Broadway II
13+
Tues
7:15 – 8:15
$485
Tap/Jazz II
-
Wed
4:00 – 5:15
$485
Technique/Production I
-
Wed
5:15 – 6:15
$485
Technique/Production II
-
Wed
6:15 – 7:30
$485
Tap/Jazz IV
-
Wed
7:30 – 8:45
$485
Acting Class (NEW)
9-18
Thurs
4:00 – 5:00
$485
Hip Hop/Lyrical I
-
Thurs
5:00 – 6:15
$485
Adult Tap
Adult
Thurs
6:15 – 7:15
$485
Hip Hop/Lyrical X
-
Thurs
7:15 - 8:30
$485
Tap/Jazz III
-
Fri
4:00 – 5:15
$485
Hip Hop/Lyrical IV
-
Fri
5:15 – 6:30
$485
Company
(By Invitation)
-
Fri
6:30 – 7:45
$485
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 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*: