On-Line STUDENT APPLICATION Items marked with a "*" are required.
Fill out one form for each student.
To help us calculate the correct fees please indicate how many students you are enrolling.
Number of students: Please choose one One Student Two Students Three Students Four or more Students ___________________________________________________________________________________
How did you hear about The Dance Academy?
Student Information
* Student Name: Required.
* Student Address: Address is required.
* Student Phone Number (ie: xxx-xxx-xxxx) A value is required. Cell Phone Number:
* Grade for '10-'11 school year: A value is required. * Age: A value is required. * Birthday: A value is required. ___________________________________________________________________________________
Parent or Guardian Information (please enter n/a in any field that does not apply) ___________________________________________________________________________________
* Mother's Name: A value is required.
* Address: A value is required.
* Phone Numbers (ie: xxx-xxx-xxxx): Home A value is required. Work Cell
E-mail Address: ___________________________________________________________________________________
* Father's Name: A value is required.
Emergency Contact Information
* Name: A value is required. * Relationship: A value is required.
* Phone Numbers (ie: xxx-xxx-xxxx): Home A value is required. Work Cell ___________________________________________________________________________________
As indicated at the top of this form please fill out one form for each student. We will calculate your fees and contact you by e-mail or phone with your final cost.
Fall 2011 Classes
Printable Class Schedule
STOP After pressing the submit button you will be taken to a thank you page. If you are not redirected to that page there may be incomplete portions of the form above. Recheck the form and make sure all fields are completed. Then press the submit button again.
