CCCD

Fall 2017 Online Registration Form

Student Name:
Age:
Date of Birth:
Street Address:
City:
Zip:
Home Phone:
Mother's Name: Work/Cell Phone:
Father's Name: Work/Cell Phone:
Email:
(Please include your email address so we can send you our monthly newsletter, event mailings, snow cancellation notices, etc. We will not share your email information with anyone.)
Emergency Contact Name: Phone:
Student's Previous Training: # of years:
Anything else we should know about your child (medical conditions, special needs, etc.)?
Requested Classes:
[Class Descriptions]
 
 
 
 
 
 
Please tell us anything else we need to know for scheduling purposes (preferences, conflicts, etc.):

Please indicate if you would like to pay your tuition monthly or be billed quarterly:



If you choose to pay on a monthly basis, payments are due the 15th of each month, September through April, and any account not paid by the 25th will be assessed a late fee. Dancers choosing to make monthly payments will NOT be sent a statement each month, but will receive a statement for costume costs.

If you choose to pay your tuition quarterly, statements will be mailed in September, November, January and March. All accounts that are not paid within the ten day payment period will be assessed a late fee. Statements will also include costume costs in November and March.

   
 

I have read the Release Form and agree to the provisions therein.

 
   
Prefer to use our paper form?
Download Here!