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225-753-6909

Auto Draft Form

Level/Day/Time: 4th Class

New Students $40 Registration Fee

Returning Students $25 Registration Fee

Level/Day/Time: 3rd Class

Student Name and Age: *

Address? *

Parent/Guardian Name: *

Level/Day/Time: 5th Class

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Fall/Spring Classes

Summer Classes

How did you hear of us? *

I understand that I will need to fill out an auto draft form for tuition for group classes. I also understand that dance is a dangerous activity and agree to hold the Dance Center and School of Performing Arts, its owner, and teachers blameless of injury that may occur during the normal scope of classes. I also understand that I am responsible for my child’s actions and assume all liability on my child’s behalf and agree that the Dance Center and School of Performing Arts, its owner, representatives, and teachers are hereby released from any and all liability. *

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PLEASE LIST CLASSES SEPARATELY Level/Day/Time: 1st Class *

Cell Phone *

Email: *

Level/Day/Time: 2nd Class

Please fill out the form, click the submit button and then go back to pay the registration fee by clicking on the payment link.