Registration Form

Student Information
Student Name*

First
Last
Previous Dance
Student Age*
Birth Date*
School
Grade
- Click here to register a second student
Student 2 Name*

First
Last
Student 2 – Previous Dance
Student 2 – Age*
Student 2 Birth Date*
Student 2 – School
Student 2 – Grade
- Click here to register a third student
Student 3 – name*

First
Last
Student 3 – Previous Dance
Student 3 – Age*
Student 3 – Birth Date*
Student 3 – School
Student 3 – Grade
If you need to register more than three students please submit a new Registration Form after completing this one. Thank you!

Parent, Guardian or Sponsor Information
Name*

First
Last
Address*

Street Address
City

State
Zip Code
Primary Phone (home/cell)*
Alternate Phone (work)
Email*
Employment
Billing Payment Method*

Payment not accepted online – please bring to studio.
Billing Information*
Billing Contact Information

Only fill this section out if the Billing Contact is different from the Parent, Guardian or Sponsor information above.
Billing Name*

First
Last
Billing Address*

Street Address
City

State
Zip Code
Billing Phone*
Billing Email*

Register for Classes

Please list the classes requested for the first student here:
Student First Name
Course Name
Date
Time

: HH

MM
Course Name
Date
Time

: HH

MM
Course Name
Date
Time

: HH

MM
- Click to request classes for Student 2
Student 2 Classes

Please list the classes requested for the second student here:
Student First Name
Course Name
Date
Time

: HH

MM
Course Name
Date
Time

: HH

MM
Course Name
Date
Time

: HH

MM
- Click to request classes for Student 3
Student 3 Classes

Please list the classes requested for the third student here:
Student First Name
Course Name
Date
Time

: HH

MM
Course Name
Date
Time

: HH

MM
Course Name
Date
Time

: HH

MM

Terms & Conditions

Variations Dance Studio does not prorate due to absences and I understand any missed classes may be made up in an alternate time. By signing below, I indicated that I fully understand and agree that the owners/ instructors of Variations shall be free of any liability of claims arising by reason of any injury or illness at Variations or any dance related activity with Variations. Permission is hereby granted to the staff of Variations to transport my child to a doctor or hospital in case of illness or injury when unable to locate the parent/guardian emergency name. By signing below, I hereby acknowledge that I am aware that performances by Variations will be videotaped strictly for private home viewing only. By signing this form, I am releasing the registered student’s image in order to participate within the performances choreographed and staged by the Variations staff/faculty.
A non-refundable registration fee of $30 for the first student and $15 for each additional student is required to complete the registration process.
Your Approval – by checking this button I am providing my electronic signature, stating that I agree to the Terms as listed above, and that all information provided is accurate and correct.
Parent, Guardian or Sponsor approval *
- I agree to the terms and conditions above

(334) 275-5013