Tip Tap Toes Dance Studio Dance Registration (2017-2018)

Tip Tap Toes Dance Studio Dance Registration (2017-2018)

Student Information

Student Name ______Date of Birth ______Age ____

Student Name ______Date Of Birth ______Age ____

Student Name ______Date Of Birth ______Age ____

Student Name ______Date Of Birth ______Age ____

Name of School ______Grade (2017-2018) ______

Cell Phone ______Email ______

Contact Information (Parents) ALL Information Is Required For At Least One Parent

Parent Name ______Relation ______

Address ______City ______State Virginia Zip ______

Cell Phone ______Work Phone ______

Employer______Email ______

Tip Tap Toes Dance Studio | 13101 Rivers Bend Blvd., Chester, VA 23836

Tip Tap Toes Dance Studio Dance Registration (2017-2018)

Parent Name ______Relation ______

Address ______City ______State Virginia Zip ______

Cell Phone ______Work Phone ______

Employer______Email ______

Person Responsible For Tuition (Other Than Parent) ______

Address ______City ______State Virginia Zip ______

Phone Number ______Email ______

Emergency Contact ______Relation ______

Best Phone Number To Reach ______Other ______

Dance Information

By initializing, I agree to participate in the Spring Dance Recital ______

·  A $30 (single students) $55 (family) performance fee will be due by Friday, October 20th

o  The performance fee includes

§  Program photo fees (Not pictures ordered directly from photographer)

§  Theatre costs, props, sets for recital

§  Each student will receive one free ticket in advance of the Thursday night recital show

Place A Check Mark By The Desired Class/Classes

Jazz ____ Tap ____ Hip Hop ____ All Boys Hip Hop ____ Ballet ____ Pointe ____ Lyrical ____ Modern ____ Baton ____ Contemporary ____ Mommy & Me ____ Tutu Cute (1-2 yrs) ____ Kinderdance (2-3 yrs) ____ Combination (4-9 yrs) ____ Private Lessons ____ Intensive (Required With Competition) ____ College/Adult ____ Acro/Gymnastics ____ Musical Theatre ____ Competition Team ____ Student Choreography ____

Preferred Days ______

Preferred Times ______

How You Learned About Us ______

Disclaimer

By signing below, I am stating that the above information is filled out to the truest and best of my ability. I also agree that if any of the above information changes, I will inform Tip Tap Toes Dance Studio of the changes.

Signature ______

Printed Name ______

Date ______

Tip Tap Toes Dance Studio | 13101 Rivers Bend Blvd., Chester, VA 23836