Register now for CCDC classes

CCDC 2011-2012 Registration

Register now for 2011-2012 classes at Capital City Dance Center.

Non-refundable annual registration fee is $20.00. Mail check to CCDC, 2962 99th Street, Urbandale, IA 50322.

* indicates a required field

Family Information

Parent Name*

Address*

City*

Zip Code*

Phone Number*

Email Address*

Confirm Email Address*

Student Information

Student Name*

Date of Birth*

School Grade*

Student Sex* MaleFemale

How did you hear about CCDC?

Class Selections Indicate level, day, and times ^‡

Creative Movement

Pre Ballet

Ballet

Pointe

Tap

Modern

Lyrical

Musical Theater

Jazz

Hip Hop

Highland

Yoga / Pilates

Other

Anti-spam question:
If the grass is green, the sky is?*

For office use only. Please leave blank.

^‡ Click on CLASSES for days and times

PLEASE READ THE FOLLOWING CAREFULLY
BEFORE YOU SUBMIT THIS FORM ELECTRONICALLY.

1. *Release from liability: I do hereby release Capital City Dance Center and its staff from any liability occurring on or around studio premises, or at any function held at other locations in connection with the dance classes in which the student named above is enrolled. I declare that the student named above is in good health and can participate in dance education classes. Given the nature of dance classes, and with the knowledge that injuries sometimes might occur, I have taken the necessary steps to obtain accident, health, or hospitalization insurance which would cover any sustained injury. In the event of an injury or emergency when I cannot be contacted, I give my permission for you to obtain medical services for the student named above.

2. *Authorization for enrollment: I authorize Capital City Dance Center to enroll the student named on this form in dance classes, and I accept responsibility for the payment of tuition for those classes for which the student is registered. I understand that classes with an enrollment of less than six pupils are subject to cancellation.

3. *I understand that the curriculum fee for annual classes is non-refundable and that there are no refunds or deductions for classes not attended.

4. *I also accept responsibility for payment of the Spring Performance Fee for the student named on this form enrolled, unless I give you written notice by December 1 of the school year that the student will not be participating.

5. *I understand that if I do not give written notice of the student’s withdrawal from classes by the 15^th of the month, I am obligated to pay the next month’s tuition.

By submitting this form I agree to items 1,2,3,4 and 5 above.

Please mail or deliver $20 registration fee to: Capital City Dance Center,
2962 99th Street, Urbandale, IA 50322.

This form uses Huggins' Email Form Script

Family Information
Parent Name*
Address*
City*
Zip Code*
Phone Number*
Email Address*
Confirm Email Address*

Student Information
Student Name*
Date of Birth*
School Grade*
Student Sex*	MaleFemale
How did you hear about CCDC?

Class Selections	Indicate level, day, and times ^‡
Creative Movement
Pre Ballet
Ballet
Pointe
Tap
Modern
Lyrical
Musical Theater
Jazz
Hip Hop
Highland
Yoga / Pilates
Other

Anti-spam question: If the grass is green, the sky is?*
For office use only. Please leave blank.
^‡ Click on CLASSES for days and times
PLEASE READ THE FOLLOWING CAREFULLY BEFORE YOU SUBMIT THIS FORM ELECTRONICALLY. 1. Release from liability: I do hereby release Capital City Dance Center and its staff from any liability occurring on or around studio premises, or at any function held at other locations in connection with the dance classes in which the student named above is enrolled. I declare that the student named above is in good health and can participate in dance education classes. Given the nature of dance classes, and with the knowledge that injuries sometimes might occur, I have taken the necessary steps to obtain accident, health, or hospitalization insurance which would cover any sustained injury. In the event of an injury or emergency when I cannot be contacted, I give my permission for you to obtain medical services for the student named above. 2. Authorization for enrollment: I authorize Capital City Dance Center to enroll the student named on this form in dance classes, and I accept responsibility for the payment of tuition for those classes for which the student is registered. I understand that classes with an enrollment of less than six pupils are subject to cancellation. 3. I understand that the curriculum fee for annual classes is non-refundable and that there are no refunds or deductions for classes not attended. 4. I also accept responsibility for payment of the Spring Performance Fee for the student named on this form enrolled, unless I give you written notice by December 1 of the school year that the student will not be participating. 5. *I understand that if I do not give written notice of the student’s withdrawal from classes by the 15^th of the month, I am obligated to pay the next month’s tuition. By submitting this form I agree to items 1,2,3,4 and 5 above. Please mail or deliver $20 registration fee to: Capital City Dance Center, 2962 99th Street, Urbandale, IA 50322.