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STUDENT NAME (Last)
(First)
STUDENT DATE OF BIRTH (Month) (Day) (Year)
ADDRESS:
CITY STATE ZIP
PHONE# CELL #
E-MAIL ADDRESS
MOTHER’S NAME WORK #
FATHER’S NAME WORK #
EMERGENCY CONTACT CONTACT #
PERSON RESPONSIBLE FOR ACCOUNT
PREVIOUS DANCE SCHOOL (if any)
DANCE EXPERIENCE (Years/Level)
ACADEMIC SCHOOLGRADE
12210 Copper Way, Suite 230, Charlotte NC 28277
"Ballantyne Area"
Please call the studio for additional information or questions
(704)-542-4998 or (704)-208-6221 *8am-9pm weekdays & weekends
REGISTRATION/ENROLLMENT FORM 2011-2012
Please complete the following information by using your "Tab" key to move through the form. Please do not hit ENTER or the SUBMIT button until you have completed the form. A CDC representative will contact you during the next few days to complete the registration process. Payment is accepted online (click on " Pay Registration Fee now " below) or may be made in cash, by check /credit card by stopping by the studio, by mail, or by speaking with a Carolina Dance Capital representative. Registration fee is $50 per dancer. ( A Registration FEE does not apply to YOGA classes)
CLASS SELECTION (Please indicate Level/Day/Time Preference)
If you do not like to submit online, you have the option to download the Registration Form and bring it to the studio. To do this, click on below. Thank you
Please print out the Policy/ Release Form to be signed before attending any classes. You may also stop by the studio to receive, complete and sign the form.
