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Student's Name *

Parent's Name(s) *

Birth Year *

Birth Month *

Birth Day *

Address *

City *

Postal Code *

Home Phone # *

Cell Phone # *

How Did You Hear About Us? *

I am a... *

New Student Returning Student

Years Experience *

Name of Previous Dance Studio *

2019 Summer Programs *

Princesses and Superheroes Camp Under the Sea Camp Flip Out! Acro Bootcamp The Dance Experience Hip Hop The Dance Experience Contemporary & Ballet The Dance Experience Jazz, Tap & Musical Theater Private Coaching Sessions

2019-2020 Pre Dance & Session Classes *

Dance With Me Early Birds Intro to Musical Theater (Winter) 4-6 Years

Session *

Preferred Class Time *

2019-2020 4-6 Years Classes *

Preferred Class Time *

Medical Conditions/Allergies *

I understand that mine or my child's spot is not held in their Summer program until the full payment has been made. I also understand that no refunds will be granted after June 15th.

I understand that mine or my child's spot is not held in their session program until the full payment has been made. I have also read the withdrawal policies.

I understand that my child's spot is not held in their seasonal class(es) until the registration fee has been paid

I have read the Summer Registration Requirements *

Yes N/A

I have read the Session Registration Requirements *

Yes N/A

I have read and understand the Seasonal Registration requirements *

Yes N/A

By checking this box I allow my child to dance at Pointflex Dance Company. I release the staff of Pointflex Dance Company of any liability in the event of an accident or illness during my child's class. I release photos of my child taken at Pointflex Dance Company or competitions and realize that they may be used for promotional material

I have read the Release of Liability *

Yes

Signature Authorization (Full Name) *

Pre Dance & Developmental Stream Recreational Registration

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