* 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* | |
| 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 | |
| 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 | |
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. | |