Class Registration Signup Form

Love 2 Dance Studio Class Registration
Student's Name *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Gender *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent 1 Full Name (if under 18)
Parent 2 Full Name (if under 18)
Email *
Classes (Check all that apply)

Toddler Ballet (up to 3 years old) Beginner Ballet (4-6 years old) Intermediate Ballet (7-9 years old) Advanced Ballet (10+) Teen Ballet Adult Ballet (18+) Belly Dance Zumba (18+) Wedding Dance Stretching
Class Type (Recreational: once/week, Semi-Professional: twice/week, Professional: three times/week)

Recreational (45 mins-1 hour: once a week) Semi-Professional (1 hour: twice a week) Professional (adult classes only, 1 hour: three times/week) Recreational (adult ballet only, 1.5 hour: once a week) Semi-Professional (1.5 hour: twice a week) Professional (1.5 hour: three times a week) Private (1 hour) Private (1.5 hour) Semi-Private (1 hour) Semi-Private (1.5 hour)
Please list any health concerns, injuries, allergies, or medical conditions.
Term/Package (check all that apply)

Term 1 (September-December) Term 2 (January- April) Term 3 (May-August) 10 class package (adult classes only) N/A
Referred By:
Additional Comments/Goals for the Class:
Should be Empty:

Love 2 Dance Studio Class Registration