Downtown Dance: Registration 2018-2019

School Year Online Registration: 2018-2019

Downtown Dance (studio) in Lewisburg Classes Begin Mon. Aug 27, 2018. www.downtowndance.org.
Questions about online registration or what class is right for you? Contact the Studio Director, Christine (Rozolis) Fairlie at DowntownDancePA@gmail.com or 570-768-9379.

We are very excited to share that will be transitioning classes from our original location at 434 Market Street (2nd Floor) in Lewisburg to 435 North 10th Street in Lewisburg. Yay, for more space!
Today's Date *

- Month - Day Year
Student's Name *

First Name Last Name
Sibling's Name (Student 2)
Sibling's Name (Student 3)

First Name Last Name
Parent's Name *

First Name Last Name
Parent's Primary Email *
example@example.com
Secondary Email *
example@example.com
Most of our communication is done through email, so please make sure you are giving us your best email address. Thank you!
Mom's Cell Number *

- Area Code Phone Number
Dad's Cell Number *

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Contact, Relation, & New Cell # *
How did you hear about us? *

Current/Past Student Facebook Instagram Google Search From a Friend School Flyer Local performance
Student's Birthday

- Month - Day Year
Date
Sibling's Birthday

- Month - Day Year
Date
Sibling's Birthday

- Month - Day Year
Date
Students' Age(s) on Aug. 27, 2018 *
Students' School(s) *
Does the dancer have any medical problems that we should be aware of? If yes, please explain. *
Download the Registration Packet *

I have a printed copy of the Registration Packet which contains the dance school year calendar, payment information, and student information.
Class Selection: *

Wed Jazz/Hip Hop, 5:40-6:25pm
If registering for siblings, please specify which child is taking which class
I understand that payment due dates are listed in the registration packet that I have downloaded. Late payments incur a late fee of $10 per occurrence.
Signature & Date *
I understand that the return fee for a bad check is $35.
Signature & Date *
I understand that tuition is NOT refundable.
Signature & Date *
By checking this box, I hereby release Downtown Dance employees and independent contractors, from all libability from personal injury, illness or property damage occuring on or off the studio's premises. I have read Downtown Dance's 2018-2019 Registration Packet of Studio Policies & Information. I authorize Downtown Dance to discharge my child to an ambulance with the nearest medical facility, should there be a medical emergency. I certify that my student is in good health and capable of participating in physcial activities. I hereby give permission to Downtown Dance to take and use photos and videos for the promotional uses of the studio. This includes, but is not limited to, the studio's facebook, instagram, twitter accounts and Youtube channel where students names are not disclosed.
I've read the above waiver. *

I agree
Signature / Date *
Dancers are expected to stay with the classthrough the May Recital. The Recital is the culmination of our School Year Program. The dates are tentatively Thursday, May 16 for the dress rehearsal & Friday, May 17 Recital, 7pm Showtimes at Susquehanna University's Weber Chapel. To be made public/offical by Feb 1! Save the dates!
Registration Fee Payment

Emma: Registration, Class & Costume $ 235.00

Total $ 0.00
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School Year Online Registration: 2018-2019