Pickerington Dance Academy Student Registration
Parent/Guardian Data
PARENT First Name:
Last Name:
Street Address:
City / State:
Zip Code:
E-mail Address:
Home Phone:
Session:
Fall Classes Summer Classes Dance Camp
Comments/Referral:
Student #1
Dancer Name:
Age:
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19+
Grade:
Interests (Select Class Times that Apply)
Ballet:
(None) Beg Ballet, Ages 4-K, 5:30 - 6:00, Monday Beg Ballet, Ages 4-K, 5:00 - 5:30, Thursday Int Ballet, Ages 5-6, 6:40-7:10, Monday Beg Ballet, Grades 1st-3rd, 6:40-7:15, Monday Beg Ballet, Grades 1st-3rd, 10:35-11:05am, Saturday Int Ballet, Grades 2nd-4th, 6:15-7:00, Tuesday Beg Ballet/Lyrical, Grades 4th+, 8:10 - 8:40, Tuesday Int/Adv Ballet, Grades 5th+, 5:55-6:40, Wednesday
Jazz:
(None) Beg Jazz, Grades 1st-3rd, 5:30-6:00, Monday Beg Jazz, Grades 1st-3rd, 11:05-11:35am, Saturday Int Jazz, Grades 2nd-4th, 5:00-5:30, Tuesday Beg Jazz, Grades 4th+, 7:40-8:10, Tuesday Int/Adv Jazz, Ages 12+, 7:45-8:15 ,Wednesday
Preschool Combo:
(None) Ages 3-4, 4:50 - 5:20pm, Monday Ages 3-4, 9:30 - 10:00am, Saturday
Hip-Hop:
(None) Beg HipHop, Grades 1st - 3rd, 7:10 - 7:40, Tuesday Beg/Int HipHop, Grades 4th+, 5:45 - 6:15, Tuesday Int/Adv HipHop, Ages 12+, 8:15 - 8:45, Wednesday
Tap:
(None) Beg Tap, Ages 4-K, 6:05 - 6:35, Monday Beg Tap, Grades 1st-3rd, 6:05 - 6:35, Monday Int Tap, Grades 2nd-4th, 5:35 - 6:05, Tuesday Beg Tap, Grades 4th+, 7:10 - 7:40, Monday Int Tap, Ages 12+, 7:40 - 8:10, Wednesday
Pointe:
(None)
Tumbling:
(None) Ages 3-6, 10:00 - 10:30am, Saturday
Lyrical:
(None) Beg Lyrical/Ballet, Grades 4th+, 8:10 - 8:40, Tuesday Int Lyrical, Grades 5th+, 6:50 - 7:35, Wednesday Adv Lyrical, Age 16+, 7:40 - 8:25, Monday
Student #2
Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th High School
(None) Beg Ballet, Ages 4-K, 5:30 - 6:00, Monday Beg Ballet, Ages 4-K, 5:00 - 5:30, Thursday Int Ballet, Ages 5-6, 6:40-7:10, Monday Beg Ballet, Grades 1st-3rd, 6:40-7:15, Monday Beg Ballet, Grades 1st-3rd, 10:35-11:05am, Saturday Beg Ballet/Lyrical, Grades 4th+, 8:10 - 8:40, Tuesday Int Ballet, Grades 2nd-4th, 6:15-7:00, Tuesday Int/Adv Ballet, Grades 5th+, 5:55-6:40, Wednesday
(None) Beg Lyrical/Ballet, Grades 4th+, 8:10 - 8:40, Tuesday Int Lyrical, Grades 5th +, 6:50 - 7:35, Wednesday Adv Lyrical, Age 16+, 7:40 - 8:25, Monday
Student #3
Pointe::
Student #4
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Check your Junk Folder if you don't receive the Confirmation email within 3 days.