Company Information
Please complete and submit this form for to register up to 3 students.
You will receive a confirmation email for your requested classes.
You will be notified if a class you requested is full.
Parent(s)/Guardian(s) Name:
Billing Address:
Suite or Apt #:
City, St, Zip:
Email:
Home Phone:
Cell/Work Phone:
Student 1 Name:
Student 1 Date of Birth:
Student 1 Class Choices:
Class title, camp or intensive
Day
Time
1.
2.
3.
4.
5.
Student 2 Name:
Student 2 Date of Birth:
Student 2 Class Choices:
Student 3 Name:
Student 3 Date of Birth:
Student 3 Class Choices:
Payment Preference
Payment Due with Registration
I will pay online (PayPal)immediately after submitting this form so I can be registered as soon as possible.
I prefer to use the EFT payment.
I prefer to mail my Summer payment to: Dance Creations, 11182 Avery Row, Fishers, IN 46038.
Refunds given only if class is cancelled due to low enrollment. We must have 5 students to hold a class.
Comments or questions:
How did you hear about us?:
As with any physical activity there is a risk of injury. I agree that I will not hold Dance Creations, LLC, East 91st Street Church, or any Faculty or Instructor responsible for any injury to my child or children.
By submitting this form, you are stating that you understand and agree with the above disclaimer.
Dance Creations, LLC 317-579-0117 Serving Fishers/Castleton/Geist Company Information
