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REGISTRATION/ENROLLMENT FORM 2017

Please complete the following information by using your “Tab” key to move through the form. Please do not hit ENTER or the SUBMIT button until you have completed the form. A CDC representative will contact you during the next few days to complete the registration process.

Payment is accepted online (click on “Pay Registration Fee now” below) or may be made in cash, by check /credit card by stopping by the studio, by mail, or by speaking with a Carolina Dance Capital representative. Registration fee is $50 per dancer.

 

How did you hear about Carolina Dance Capital?*
(Please select your answer below)

Student:

Student:

Gender:

Date of Birth:

Street Address:

City:

State:

Zip:

Main Phone No:

Mobile No:

E-mail:

Mother's Name & Phone No:
,

Father's Name & Phone No:
,

Emergency Contact Person 1:
,

Emergency Contact Person 2:
,

Previous Dance School:

Dance Experience (Years & Level):

Academic School & Grade: ,

CLASS SELECTION:

(Please indicate Level/Day/Time Preference)

Please leave this field empty.