2011-12 Online Registration

Each student must have a separate registration form (even siblings). Please fill out completely. Remember your spot will only be held in the class of your choice with registration fees paid.

• Student Information:

Student Name:

Student Age: Student DOB:

Previous Experience:


Special Needs (if any):

• Parent/Guardian & Contact Info:

Parent/Guardian Name:

Complete Mailing Address:



Day Phone:

Evening Phone:

Mobile Phone:

E-Mail Address:

• Emergency Contact Info:

Please note: The information provided in this section must be someone other than parent/guardian listed above. Studio 4 Dance will always attempt to contact a parent/guardian first in case of an emergency. This section\'s purpose is in the event a parent/guardian cannot be reached.

Emergency Contact Name:

Relationship to Student:

Emergency Contact Phone:

• Choose Your Classes:

Please choose all that apply for the student listed above. However, teachers at Studio 4 Dance reserve the right to move students to a different class that may be better suited for this particular student. You are currently choosing your preferred classes.

 Mon 4:00-5:00 • 3-4 yr • Pre-Ballet/Tap

 CLOSED Mon 5:00-6:30 • 5-7 yrs • Tap/Ballet/Jazz

 CLOSED Mon 5:00-6:00 • 5-7 yrs • Tap/Ballet

 CLOSED Mon 5:30-6:30 • 5-7 yrs • Ballet/Jazz

 Mon 6:30-7:30 • Teen Tap

 Mon 7:30-8:30 • Teen Jazz

 Tues 7:00-8:30 • Ballet/Pointe

 Wed 4:30-6:30 • 8-10 yrs • Tap(30)/Ballet(45)/Jazz(45)

 Wed 4:30-5:45 • 8-10 yrs • Tap(30)/Ballet(45)

 Wed 5:00-6:30 • 8-10 yrs • Ballet/Jazz

 Wed 6:30-7:30 • Pre-Teen Jazz

 Thurs 6:00-7:30 • Ballet/Pre-Pointe

 Thurs 7:30-8:30 • Pointe (every other week)

 Fri 6:00-7:00 • Kung Fu • Child

 Fri 7:00-8:00 • Kung Fu • Adult

 Sat 10-11:00 • 3-4 yrs • Pre-Ballet/Tap

 Sat 11:00-12:30 • 5-7 yrs • Tap/Ballet/Jazz

 Sat 11:00-12:00 • 5-7 yrs • Tap/Ballet

 Sat 11:30-12:30 • 5-7 yrs • Ballet/Jazz

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