Registration

Student Name(s)(Required)

D. O. B

Mom’s Email(Required)

Dad’s Email(Required)

Address

Street Address City State Zip Code

Mom Cell Phone

Dad Cell Phone

Emergency Contact(Required)

Emergency Phone(Required)

Email(Required)

Allergies or Medical

Class Choice

Summer Class

Fancy Feet (Ballet/Jazz/Tap) Ages 3-5

Ballet/jazz/tap Ages 6-9

Ballet/lyrical Ages 10 and up

Tap/Jazz Ages 10 and up

GoJu Karate/Tumbling (Boys and Girls 3-4 yr)(Required)

Rhythmettes (Ballet and Creative Dance) (Boys & Girls 3-4 yr)(Required)

Hip Hop (5 & 6 years of age)(Required)

Rhythmettes (Ballet and Creative Dance) (Boys & Girls 3 yr)(Required)

Irish Beginner Class (All Ages)(Required)

Petite Troupe (Ballet, Jazz, Tap) (7-8 yr)(Required)

Mini Troupe (Ballet, Tap, Jazz) (7-10yr)(Required)

Contemporary (10 & up)(Required)

Jr. Troupe (Ballet, Jazz & Tap) (10-13 yr)(Required)

Fairytales (Boys & Girls Age 2)(Required)

Fancy Feet (Ballet and Tap) (Boys & Girls 4 yr)(Required)

Acro-Tubmling (Boys & Girls 3-4 yr)(Required)

Acro / Jazz (6-9 years)(Required)

Acro / Jazz (Boys and Girls 10 years and up)(Required)

Ninja Acro Course (Boys & Girls 3-4 yr)(Required)

Baton (Boys & Girls All Ages)(Required)

Hip Hop (7 - 10 yr)(Required)

Elite Hip Hop (11 yr and up)(Required)

Sr .Troupe Jazz and Tap (Ability/Level)(Required)

Sr. Troupe Ballet (Ability/Level)(Required)

Adult Tap(Required)

Adult Jazz(Required)

Mini Competition Team (Ability/Level)(Required)

Senior Competition Team (Ability/Level)(Required)

Showstoppers - Ballet and Tap (5-6 year olds)(Required)

Fancy Feet (Ballet/Jazz/Tap) Ages 3-5(Required)

Ballet/jazz/tap Ages 6-9(Required)

Ballet/lyrical Ages 10 and up(Required)

Tap/Jazz Ages 10 and up(Required)

Tiny Twirl and Tumble (Parents Participation Required) (2-3 yr)(Required)

Pointe (ability/level)(Required)

Tap 5-7 yr(Required)

Creation Academy Student

Yes

The undersigned parent/student indemnifies and agrees to holds harmless Dee Dots Dance Academy (DDCA), its Board of Directors, officers, instructors, agents, and assigns from any and all liability whatsoever, for any damage or injuries, and from any and all claims and demands, including attorney fees, arising out of the party’s participation in dance lessons, classes, workshops, performances, karate, fundraisers and other related activities provided by and/or at the facility of DDCA. The undersigned parent/student understands that students may occasionally appear in promotional performance videos, photos, brochures, and other materials as a result of his/her association with DDCA. By registering a child/student for class, such use of the child/student’s name and likeness are agreed to and acknowledged and, accordingly, all right, title and interest in same are waived.

Date

Printed Name

Signature

(Parent's signature if student is under 18)

DEE DOTS

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