Registration Form

2022-2023 Student Registration

Please complete and submit a student enrollment form for each dancer

Student Name
*
Age (For adult students you may simply state "adult")
*
Date of Birth (MM/DD/YY)
*
Years of Previous Ballet Training
*

Little to none
1 year
2 years
3 years
4 years
5 years or more
Adult Classes Registration (Select all that apply.)
Adult Tap
Adult Jazz
Adult Shag
Adult Ballet
Parent/Guardian
*
Parent/Guardian Home Address: Street Number, Street and Apt.#
*
Parent/Guardian Home Address: City, State, Zip Code
*
Parent/Guardian Email Address
*
Parent/Guardian Cell Phone
*
Student Email Address (if applicable)
Student Cell Phone (if applicable)
Emergency Contact Information - Please include Name, Phone number and relationship to dancer
*
Allergies and/or Medical Conditions
*
Preferred Schedule of Payments
*
Annual Tuition- 1 payment due August 8th (10% discount in rate)
Trimester Tuition- Due August 8th, November 14th & February 13th
Photo Release Consent -- Palmetto Conservatory of Dance has my permission to use my or my child’s photograph publically to promote the school. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
*
I Agree
I Do Not Agree
Parent/Guardian Electronic Signature