Register for Butterfly Classes

INSTRUCTIONS

1. From the Class Schedule page determine which class(es) you would like to register for and get the class #(s).

2. Fill in the blanks below to register for a dance class. All boxes marked with an asterist (*) must be filled in.

3.For new students there is a one time $25 non-refundable registration fee that must be paid before the online registration is valid. If you took with us during the prior dance year no registration fee is required.

You will be sent an e-mail confirmation of your registration.

*Student Name:
*Address:
*Phone #:
*Date of Birth:
*Billing Contact Name:
*Phone number:
*Emergency Phone/Cell number:
*Address:
Doctor:
Doctor's Phone:
*First Class #:
Second Class #:
Third Class #:
Fourth Class #:
*E-Mail Address:
*Has your child ever had a broken bone? Yes-explain/No
*Does your child have any joint problems? Yes-explain/No
*Does your child have any heart or circulatory problems? Yes-explain/No
*Does your child have any spinal or hip problems?Yes-explain/No
*Has your child ever had surgery? Yes-explain/No
*Does your child have a learning disability? Yes-explain/No
*Does your child take any ongoing medication? Yes-explain/No
*Does your child have any resperatory problems? Yes-explain/No
*Is your child in relativley good health? Yes/No