Registration Form

Submitted by admin on Tue, 11/27/2012 - 22:56

Fall 2018-19 SEATTLE:
September 10, 2018-January 16, 2019
16 weeks, $275
We accept late registrations at prorated cost.

Fall 2018 BELLINGHAM: TBA

Click on the class drop down menu to register. After you submit the form you will receive an email with instructions for making payment and confirming your registration was received, usually within 2 business days. If you don't see it in your inbox, please check your junk mail. Any problems with registering, please call Darrah's cell at two-zero-six-two-eight-one-nine-eight-one-five.
Please be sure to read the policy regarding parents viewing classes on the FAQ page before submitting registration.
DB=Instructor is Darrah Blanton DC=Instructor is Dakota Crist

Class: *

Student Name: *

Date of Birth: *

Phone (Cellular): *

Phone (Work): *

Phone (Home): *

Phone (Emergency): *

Parents’ Names: *

Address 1: *

Address 2:

City: *

Zip: *

Email address: *

Please describe any special needs or health history you would like me to be aware of:

Release Form: *

I agree to let my child participate in the dance program of Darrah Blanton, and hereby release Darrah Blanton and/or Dakota Crist from liability for any injury my child may incur as a result of their participation.

Release signature: *

Type the name of the parent or guardian completing the form.

Release Date: *

Photo Release: *

Allow the use of photographs and/or video of my child

Please refrain from using photographs and/or video of my child

Periodically the website is updated with photos and/or video. Please indicate above whether you would allow photos and/or video of your child to appear online at
www.darrahblantondance.com and to be used in printed materials for advertising purposes.

Refund Policy: Refunds/credits are not available after August 25 for fall classes. Cancellations prior to this date will incur a $50 cancellation fee per registration.: *

I understand and agree to the refund policy.

How did you hear about us?: *

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