Online Dance Class Registration Form
ONLINE CLASS SCHEDULE
Hip Hop
Mondays
9:00 AM - 12:00 PM
Jazz
Tuesdays
9:00 AM - 12:00 PM
Ballet
Wednesdays
9:00 AM - 12:00 PM
Ballroom
Thursdays
9:00 AM - 12:00 PM
Salsa
Fridays
9:00 AM - 12:00 PM
Bachata
Saturdays
9:00 AM - 12:00 PM
Tango
Sundays
9:00 AM - 12:00 PM
Student Information
Name
First Name
Last Name
Age
*
Gender
Male
Female
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Write something about yourself
Parent/Guardian Information
For minors (below 18 years of age)
Parent/Guardian Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Relationship
Miscellaneous
How do you learn about this online dance class?
Facebook
Twitter
Instagram
YouTube
Search Engine
Online Ads
Referral
Other
Shirt Size
S
M
L
XL
XXL
Do you want to add enroll more students?
Yes
No
Additional students
Payment & Confirmation
Registration Fee
prev
next
( X )
Hip Hop
$15.00
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Jazz
$20.00
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Ballet
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Ballroom
$18.00
$
18.00
Quantity
1
2
3
4
5
6
7
8
9
10
Salsa
$18.00
$
18.00
Quantity
1
2
3
4
5
6
7
8
9
10
Bachata
$18.00
$
18.00
Quantity
1
2
3
4
5
6
7
8
9
10
Tango
$18.00
$
18.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$0.00
$
0.00
Payment Method
Cash
Credit Card
Check
PayPal
Other
Signature of Student
Date Signed
-
Month
-
Day
Year
Date
Parent/guardian Name
First Name
Last Name
Parent/guardian Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Print Form
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