Registration

Prefix *

Student First Name *

Student Last Name *

Suffix *

Student Birth Date (mm/dd/yyyy) *

Name of School *

Grade Level *

Student Address *

Line 1

Line 2

City

State

Zip Code

Country

Is the Student Address the same as the Parent Address? *

Yes No

Parent Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Name *

First

Last

Phone Number *

Parent/Guardian Email *

Alternate Phone Number *

First Day of Class (mm/dd/yyyy) *

Please list any previous dance studio experience or education. *

Does your child have any allergies, medications, or health conditions that our instructors need to be aware of? *

How did you hear about Children's Center for Dance Education? *

A registration fee of $35.00 per year per family is due at the time of registration along with the first months tuition. Fee may be paid online, mailed to Children's Center for Dance Education at 5900 Vogel Rd. Ste. A Evansville, IN 47715 or placed inside the tuition drop box during regular studio hours. Please include child's name when paying registration. *

I agree to adhere to pay a registration fee of $35.00

I will notify CCDE, if my child(ren) discontinues classes. *

I agree.

I agree that I or my child(ren) may be photographed for media use and promotional coverage for Children's Center for Dance Education. Only CCDE approved creatives may take videos or photographs for the organization. *

Yes, I agree. I prefer not to have my child(ren) photographed.

I understand and agree with the financial policy. *

I agree.

I certify that all information provided is true and complete to the best of my knowledge. I authorize the verification of any or all information listed above for billing purposes. *

I agree.

THIS IS YOUR SIGNATURE. Please type your full name. By signing, you are agreeing to all legally binding terms and conditions of this contract, and by signing you agree to adhere to these terms. Children's Center for Dance Education reserves the right to change these terms at any time. Please read through all terms each year at registration. *

I, the undersigned, agree that I will not hold Children's Center for Dance Education, board of directors, staff, volunteers, or designees liable for any illness or injury obtained by me or my child(ren) while being present at the CCDE studio or performance locations or parking lots or premises thereof, for reasons other than taking part as a student or performer, to observe classes, whether or not enrolled as students. *

I agree.

Children's Center for Dance Education Dance Registration