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:

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. Please be aware that Dancenter may take photographs of its dancers
for use in promotion of the studio. If this is not your wish, please attach a letter stating this to your registration form.

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.
These fees are non-refundable.
There is NO registration fee for the 5-week Summer Session.
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