Registration
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Pickerington Dance Academy Student Registration

Parent/Guardian Data

Parents Last Name:

Parents First Name:

Street Address:

City / State:

    

Zip Code:

E-mail Address:

Home Phone:

Session:

Referral/Comments:

  

Pay By Credit Card?

Student Data

Student or Child #1

Name:

 

Age:

 

New Student?

 

Experience

Level:

Grade:

 

Interests (Select Class Times that Apply)

Ballet:

Jazz:

Preschool Combo:

Hip-Hop:

Tap:

Cheerleading:

Tumbling:

  

Student or Child #2

Name:

 

Age:

 

New Student?

 

Experience

Level:

Grade:

 

Interests (Select Class Times that Apply)

Ballet:

Jazz:

Preschool Combo:

Hip-Hop:

Tap:

Cheerleading:

Tumbling:

 

 

Student or Child #3

Name:

 

Age:

 

New Student?

 

Experience

Level:

Grade:

 

Interests (Select Class Times that Apply)

Ballet:

Jazz:

Preschool Combo:

Hip-Hop:

Tap:

Cheerleading:

Tumbling:

 

 

Student or Child #4

Name:

 

Age:

 

New Student?

 

Experience

Level:

Grade:

 

Interests (Select Class Times that Apply)

Ballet:

Jazz:

Preschool Combo:

Hip-Hop:

Tap:

Cheerleading:

Tumbling:

 

 

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Home | About the Studio | About the Director | Classes Offered | Schedule | Registration | Rules & Guidelines | News & Events