Register now for Summer 2011 classes at Capital City Dance Center.

Annual registration fee is $20.00 for students new to CCDC.
Please mail check to CCDC, 2962 99th Street, Urbandale, IA 50322.

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Family Information
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Student Information
Student Name*
Date of Birth*
Student Sex*	MaleFemale
Summer Programs
Class Selection
Summer Intensive: (June 13 - June 24)
One week Workshops: (June 20 - June 24 and/or July 18 - July 22)
Summer Workshop: (June 27 - August 13)
Select classes desired from list below
Class Selections	Indicate level or other information ‡
Pointe
Ballet
Modern
Jazz
HipHop
Boys
Creative Movement
Pre Ballet
Lyrical
Pilates
Other
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‡ 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 understand that if I do not give written notice of the student’s withdrawal from classes by the 15th of the month, I am obligated to pay the next month’s tuition. By submitting this form I agree to items 1, 2, 3, and 4 above. Please mail or deliver $20 registration fee to: Capital City Dance Center, 2962 99th Street, Urbandale, IA 50322.