Student Registration Form

Student First Name*

Student Last Name*

Date of Birth*

Gender* FemaleMale

Street Address*

City*

Postal Code*

Phone*

Parent or Adult Student Email*

Children/Teens:

Parents or Guardians names

Parent's Cell #'s

Academic School

Student Email

All Students:

Other family members in this academy

New student this year?* NoYes

# Years of dance experience*

Desired classes:

CHILD/TEEN: check all that apply (Competition classes by audition only)
Ballet 1 (most advanced)Ballet 2Ballet 3Ballet 4Advanced 2 Ballet (most advanced)Advanced 1 BalletIntermediate BalletGrade 5 BalletGrade 3 BalletGrade 1 BalletPrimary BalletPre-school BalletPointe 1 (most advanced)Pointe 2Pointe 3Teen Ballet & TechniqueAdvanced 2 Modern (most advanced)Advanced 1 ModernIntermediate ModernGrade 6 ModernGrade 5 ModernGrade 3 ModernGrade 2 ModernAdvanced 2 Tap (most advanced)Advanced 1 TapIntermediate TapGrade 5 TapBronze/Grade 3 TapTeen TapKids' Hip HopPre-Teen Hip HopTeen Rec Hip HopHip Hop TechniqueKids JazzJunior Tech JazzPost award JazzInter/Senior Jazz TechniqueInter/Senior Technique/improvTeen Contemporary JazzPre-school Creative DanceTiny TumblersFoundations acrobatics AFoundations acrobatics BIntermediate Foundations AcrobaticsPrep TNT (pre-comp)Teen TNT ATeen TNT BCompetitive Junior/Inter JazzCompetitive Inter/Senior JazzCompetitive Inter ContemporaryCompetitive Senior ContemporaryOpen Competitive Performance JazzInter/Senior Competitive LyricalCompetitive Inter Hip HopCompetitive Senior Hip Hop

ADULT: check all that apply (Competition classes by audition only)
Adult Cardio CabaretAdult TapAdult Sassy JazzAdult BalletAdult Hip Hop/GrooveAdult Competitive Street Jazz