A $25 non-refundable deposit required to reserve class and complete registration. If you are registering for a summer camp the full amount due must be paid. Dance Camps $75 and Workshops $20. Thank you.
Participant: Last Name: First Name: MI:
Date Of Birth (XX/XX/XX): Age: Gender:
Address:
City: State: Zip Code:
Phone: Email:
Do you have prior dance training?
If so, where?
What style(s) of dance did you study?
How many years?
Parent/Guardian: (if under 18) Title (Mr, Mrs, Ms):
Last Name: First Name:
Address:(if different from above)
Daytime Phone: Evening Phone: Cellular Phone: Email:
Alternate Emergency Contact Information:
Name:
Relation To Student:
Daytime Phone: Evening Phone:
Cellular Phone:
Preferred Hospital:
Physician:
Beginning Jazz (ages 5-9) Beginning Ballet(ages 5-9)Sat. Beginning Ballet (ages 5-9)Monday Adv. Beg. Ballet (ages 7-11)Tues Beginning Tap (ages 5-9) Intermediate Jazz (ages 8-15) Intermediate Ballet (ages 8-15) Teen/Adult Int. Ballet Intermediate Tap (ages 8-15) Intermediate Lyrical (ages 8-15) Int./Adv. Ballet/Pre-Pointe (10 & Up) Adv. Beg. Jazz (6-11) Advanced Jazz ( 12 & up) Advanced Ballet/Pointe (12 & up) Advanced Tap (12 & up) Advanced Lyrical (12 & up) Lil' Hip Hop Wed. (ages 4-7) Lil' Hip Hop Sat. (5-8) 2:00-2:45pm Hip Hop 1 Sat. (9-14) 12:30pm Hip Hop 2 (ages 8-12) Thurs. 4:00pm Hip Hop 1(ages 8-12) Thurs. 4:45pm Hip Hop 3 (Int. /Adv. Placement) Hip Hop 4 (Adv. placement)
I understand that monthly payments are due at the 1 st of every month and a $20.00 late fee will be charged if not received by the 7 th of the month. I also understand that if a cancellation of a class or classes is to occur that a written notification is to be given to the Office Manager and final payment needs to be made at that time.
A $25 non-refundable deposit required to reserve class and complete registration. You will be prompted for payment on next page.
If you are registering for a summer camp the full amount due must be paid. Dance Camps $75 and Workshops $20. Thank you.
(must be checked) I agree the above information and have read, understand and agree to the terms and policies of Dance Matrix.
40975 N. Ironwood Suite B-111 Queen Creek, AZ 85242 480-987-3073 email us
