Registration Form

DATE NEW STUDENT RETURNING STUDENT AGE BIRTHDATE

STUDENTS LAST NAME FIRST MIDDLE

PARENT / GUARDIAN NAME (IF UNDER 18)

ADDRESS: STREET NUMBER AND NAME (NO P.O. BOX)

CITY STATE / ZIP

MAILING ADDRESS (IF DIFFERENT)

HOME PHONE WORK PHONE

E-MAIL ADDRESS:

Are there any special medical conditions or circumstances we should know about (confidential):

Permission to participate in classes offered by Dancenter is given for my minor child or me as shown above.
I assume all risks involved in taking classes, including travel to and from Dancenter, and hold harmless Dancenter,
its employees and it's consultants, from all liability. I agree that photos and videos taken by Dancenter may be used for future promotional purposes. I have read and agree with the policies of Dancenter.

STUDENT SIGNATURE (OR PARENT/GUARDIAN IF STUDENT IS UNDER 18)

Use one form per student. Please fill out the full form. $30 Registration fee and first month's tuition must accompany registration. NO REGISTRATION FEE is required for the Summer Session.
These fees are non-refundable and non-transferable.
Please enclose and write student’s name on check. Make check out to “Dancenter”
Please return THIS FORM to: Dancenter, 810 A Bay Ave. Capitola 95010.
Return a separate form and registration fee for each student in a family.

PLEASE LIST THE NAME, DAY, AND TIME OF CLASS(ES) YOU WANT:

CLASS 1 DAY TIME

CLASS 2 DAY TIME

CLASS 3 DAY TIME

CLASS 4 DAY TIME

CLASS 5 DAY TIME

CLASS 6 DAY TIME

CLASS 7 DAY TIME

CLASS 8 DAY TIME

CLASS 9 DAY TIME

CLASS 10 DAY TIME

CLASS 11 DAY TIME

CLASS 12 DAY TIME

CLASS 13 DAY TIME

CLASS 14 DAY TIME

CLASS 15 DAY TIME

CLASS 16 DAY TIME

CLASS 17 DAY TIME

CLASS 18 DAY TIME