Registration Form

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

Summer 2019 SEATTLE
Session B: Tuesdays July 2-August 6 (6 weeks, $105) Ballard

Capitol Hill and Bellingham classes resume in Fall 2019

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 HS=Instructor is Hayley Shannon

Class *

Student Name *

Date of Birth *

Month

Day

Year

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, Dakota Crist and Hayley Shannon 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 *

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 May 1 for Summer classes, August 25 for fall classes or after December 11 for Winter/Spring 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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