Registration Form

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

Summer Session B (ONLINE) Registration open now
Wednesdays with Dakota
August 5-September 2
10am creative pre-ballet ages 3-5
11am creative ballet ages 5-8
5 weeks, $50
classes listed in drop down menu

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.

DC=Instructor is Dakota Crist HS=Instructor is Hayley Shannon
DB=Instructor is Darrah Blanton

Class *

Student Name *

Date of Birth *

Month

Day

Year

Phone (Cellular) *

Preferred Pronouns

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 us 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, Dakota Crist and Hayley Shannon from liability for any injury my child may incur as a result of their participation in online and/or in-person classes.

Release signature *

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

Release Date *

Month

Day

Year

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 20 for fall classes, after November 15 for Winter/Spring classes, or after May 1 for Summer classes. Cancellations prior to these dates 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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