Registration
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Pickerington Dance Academy Student Registration

Parent/Guardian Data

Parents Last Name:

First Name:

Street Address:

City / State:

    

Zip Code:

E-mail Address:

Home Phone:

 

Session:

Comments/Referral:

 

Student Data

Student or Child #1

Name:

 

Age:

 

Grade:

Interests (Select Class Times that Apply)

Combo:

Ballet:

Competition:

Camp:

Jazz / Hip-Hop  Combo:

Creative Movement:

Student or Child #2

Name:

 

Age:

  

Grade:

 

Interests (Select Class Times that Apply)

Combo:

Ballet:

Competition:

Camp:

Jazz / Hip-Hop Combo:

Creative Movement:

Student or Child #3

Name:

 

Age:

  

Grade:

Interests (Select Class Times that Apply)

Combo:

Ballet:

Competition:

Camp:

Jazz / Hip-Hop Combo:

Creative Movement:

Student or Child #4

Name:

 

Age:

  

Grade:

Interests (Select Class Times that Apply)

Combo:

Ballet:

Competition:

Camp:

Jazz / Hip-Hop Combo:

Creative Movement:

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