Contact

Parent Name #1 *

Parent Name #1

First Name

Last Name

Email Address #1 *

Email Options #1

(We will never share, sell, or rent individual personal information with anyone. Information submitted to us is only used for purposes of contacting you based on your request for information)

Please send me updates about classes to this email

This is not an email that my family would like to be contacted at

Email Address #2

Email Options #2

Please send me updates about classes to this email

This is not an email that my family would like to be contacted at

If your address, phone number, or email changed, please indicate the updates below, or if there is any additional contact information that we should know, please include below.

Registrants

Child #1 Name *

Child #1 Name

First Name

Last Name

Child #1 Birthday *

Child #1 Birthday

YYYY

Age on September 18, 2018 *

School and Grade Level

Desired Class(es) for Child #1 *

Tuesdays, 3:15-4:15 pm | Technique for ages 4-7

Tuesdays, 4:25-5:25 pm | Technique for ages 8-10

Wednesdays, 4:20-5:20 pm | Technique for ages 11-14

Wednesdays, 5:25-6:25 | Repertory for ages 8+

Child #2 Name

First Name

Last Name

Child #2 Birthday

YYYY

Age on September 18, 2018

School and Grade Level

Desired Class(es) for Child #2

Tuesdays, 3:15-4:15 pm | Technique for ages 4-7

Tuesdays, 4:25-5:25 pm | Technique for ages 8-10

Wednesdays, 4:20-5:20 pm | Technique for ages 11-14

Wednesdays, 5:25-6:25 | Repertory for ages 8+

Do you have any notes or updates about you and your family that the instructor should know? *

How would you like to pay? *

Online (PayPal)

Check to Word Dance Theater

Cash

Authorization *

All photos and videos used by Word Dance Theater are for the sole use of publicizing the Youth Program and all parents will be notified before a photo or video is published.

I authorize Word Dance Theater to use images of my child/children, including their face(s)

I authorize Word Dance Theater to use images of my child/children, but their face(s) may not be in the image

I do not authorize Word Dance Theater to use images of my child/children

To finish registration: *

(Specific information on how to pay is on the Registration Details page)

I understand that registration is not complete until payment is received. After clicking "SUBMIT" I will wait for the PayPal button to appear, then follow that link to online payment, or mail a check.

Thank you! Please click on the green tuition payment below to complete your registration.

Fees
Early Bird: $250 per child before December 15, 2018
Regular: $280 per child after December 15, 2018

Please make sure you have read our How To Register page before proceeding below. This form is for returning students only. Follow this link for new student registration >>

Returning Student Registration Form