Class Registration Signup Form

Love 2 Dance Studio Class Registration
Student's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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 BalletAdult Ballet (18+)Belly DanceZumba (18+)Wedding DanceStretching
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