DANCE CLASS REGISTRATION AT DSD

Register by Paper:
If you want to fill out a paper registration form, please click here to download in order to print.

Register Online:
Please fill out the form below to register online for Dance classes.

Your Name (required):

Your Email (required):

Your Home Address, City, State, Zip:

Your Phone:

Your Child's Name:

Child's Date of Birth:

Child's Grade:

Child's School:

Child's Mother's Name:

Child's Mother's Phone Number:

Child's Father's Name:

Child's Father's Phone Number:

Emergency Contact Name other than Parent:

Emergency Contact Phone Number:

Allergies or other medical information:

Is there anything we need to know about your child that will help us to better serve him or her?

Previous Dance Experience (if so, when and where):

List the EARLIEST TIME of the day that your child can attend class:

List the days that are IMPOSSIBLE for your child to attend class:

List any other activities your child is involved in that may conflict with dance classes:

Pick your class choices (may choose more than one by holding the shift key down while clicking on the choices):

If your child is in Middle or High School, is he or she interested in a performing group?
Not ApplicableYesNo

How did you hear about our program?

If you were referred to our program, please tell us the name of that person.

Release: I hereby accept full financial responsibility for injury to my child that may occur at or near Douglasville School of Dance before, during, or after classes including function held away from the classroom building. In case of accident when I cannot be reached I hereby give my permission for Sheryl Clay or my child's teacher to seek medical aid in any emergencies. In addition, I give my permission for Douglasville School of Dance to film my child during the school activities, and I authorize the use of my child's pictures or videos for advertising purposes. I am aware that Douglasville School of Dance has the right to combine or cancel classes due to low enrollment.

Please type your name below as your signature as well as the date to indicate your agreement in this release statement.