Participant's Name
*
First Name
Last Name
Gender
Female
Male
Birthday
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
School
Parent 1
*
First Name
Last Name
Parent 1 Employer
Parent 1 Cell Phone
*
(###)
###
####
Parent 1 Work Phone
(###)
###
####
Parent 1 Email Address
*
Parent 2
First Name
Last Name
Parent 2 Employer
Parent 2 Cell Phone
(###)
###
####
Parent 2 Work Phone
(###)
###
####
Parent 2 Email Address
Emergency Contact
*
Relationship to Student
*
Emergency Contact Phone
*
(###)
###
####
Participant Healthcare Provider
*
Healthcare Provider Contact Number
*
(###)
###
####
Registering for Classes: Keiki Ballet
Registering for Classes: Children's Ballet Technique
Registering for Classes: Dance Enrichment
Registering for Classes: Private Lessons
For Private Lessons: Date and Time
Performance Registration:
*
Please check your dancer's participation in the following:
KDA Studio Policies
*
KDA Liability Waiver and Talent Release
*
Commitment Agreement
*
Tuition Payment: Please select how you would like to pay tuition
*
Pay In Full
Payment Plan
Please Note: A registration form alone does not guarantee a place in class. Once we have received your registration, we will send a tuition invoice with your payment preference (pay in full or payment plan). A dancer is only considered enrolled in a class once tuition has been received.
*
