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Student's Name
*
Parent's Name(s)
*
Birth Year
*
2018
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1989 or earlier
Birth Month
*
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Birth Day
*
1
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Gender
*
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Address
*
City
*
Postal Code
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Home Phone #
*
Cell Phone #
*
Cell Phone #
*
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*
*
Indicates required field
How Did You Hear About Us?
*
Facebook
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I am a...
*
New Student
Returning Student
Years Experience
*
Name of Previous Dance Studio
*
Preferred Location
*
2406 Victoria Avenue East
2351 2nd Avenue
2019 Spring Adult Classes
*
_Tap (Beginner/Intermediate)
_Tap (Intermediate/Advanced)
_Jazz (Intermediate/Advanced)
_Ballet (Multi-Level)
_Contemporary (Multi-Level)
_Hip Hop (Beginner/Intermediate)
_Hip Hop (Intermediate/Advanced)
Session
*
N/A
Fall 10 Week Session
Winter 10 Week Session
Spring 6 week session
Spring Session Pre Dance Classes
*
_Dance With Me (18 months - 3 years)
_Early Birds (3 - 4 years)
Please Note Preferred Class Time
*
N/A
Weekday Evening
Saturday
6 Week Spring Session Classes
*
_Creative Movement (4-6 years)
_Intro to Tumbling (4-6 years)
_Intro to Musical Theater (4-6 years)
_Hip Hop (5 & under)
_Hip Hop (6-9 years)
_Hip Hop (10-12 years)
_Hip Hop (13+ years)
Please Note Preferred Class Time
*
N/A
Weekday Evening
Saturday
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 have read the Summer Registration Requirements
*
Yes
N/A
I have read the Session 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)
*
Register