Class Registration – Center Stage Dance

Tell Us About Dancer

First Name:

Last Name:

Please list the student's age and grade as of this coming September

Birth Date:

Age:

Grade:

School Hours:

Physical Limitations:

Previous Dance Training:

Contact Information

Email Address: (Center Stage uses email as our primary means of communicating important studio information)

Street Address:

City:

State:

Zip:

Home Phone:

Parent 1:

Work Phone:

Cell Phone:

Parent 2:

Work Phone:

Cell Phone:

Class Selection

Classes denoted with an * require an audition or recommendation. If your desired class is not appearing below the class is full and closed to registration. Please make another selection or call 203-329-6676 to be placed on the waiting list.

Class:

Day:

Time:

Class:

Day:

Time:

Class:

Day:

Time:

Class:

Day:

Time:

Payment Method, Acknowledgment & Release

Please indicate your method of payment

Pay tuition in full and receive a 5% discount

Pay in 3 trimester payments
(due at Registration, November 1st and February 1st)

I hereby release Center Stage Dance Studio from any and all liability and assume the risks of participating in the Center Stage Dance Studio program. I hereby give Center Stage Dance Studio permission to photograph and/or video my child(ren) and consent to the use of material for advertising, marketing and promotional purposes. By submitting this form you hereby certify that all of the above information is true and accurate and that you are in full acceptance of the aforementioned terms. By signing, I acknowledge my responsibility in paying tuition, registration and costume fees.

Insert you full name:

Registration is complete only AFTER 1st Payment is Received.