Registration Form

Registration Information

IMPORTANT: Please fill out the form below to register for classes. Please fill out a new form for each class you would like to take.
Class placement is not guaranteed until payment is received, and is on a first come, first serve basis.

For Fall Classes: To Confirm Registration the 1st monthly payment will need to be submitted (including a non-refundable $20.00 registration fee for new students). Payable by check, cash, or credit card. (Please note: registration is not confirmed until payment is received.)

For Winter Semester classes: a non-refundable $20.00 registration fee for all new students is due upon registration. Payment is due in full at the time of registration.

All new students will pay a one time non-refundable family registration fee of $20.00 at the time of sign-up.

Registration Form
Please fill out all required (*) fields. Incomplete forms cannot be submitted.

* Indicates required field

Student Name *

First

Last

Birthdate (mm/dd/yyyy) *

Age *

Parent Name *

First

Last

Primary Phone Number *

Select One *

Alternate Number *

Select One *

If other, please indicate whose number is listed: *

Address *

City *

State *

Zip *

Mailing List *

Please add me to your student mailing list

Email: *

1st Choice Class Selection *

Day *

Time *

Please select an alternative class choice. This can mean a different time for your first class choice.

2nd Choice Class Selection *

Day *

Time *

Explain *

Liability Waiver As the parent/guardian of the above mentioned child, I am aware that any physical movement program could result in injury and I permit my child to participate in such a program and release LimeLight Dance Studio, its owners, employees and staff from all liability for injury, from his/her participation in the program. I also agree to allow LimeLight Dance Studio to use photographic image or video of my child (without identification) for advertising or promotional purposes. As the parent/guardian of the above mentioned child, I have read and understand the terms of this agreement and will abide by the above mentioned guidelines.

By clicking the box below, I accept the terms of this agreement and will abide by the above mentioned guidelines. *

I accept

Please click the "SUBMIT" button once you have completely filled out this form. Incomplete forms cannot be submitted.

Submit

Registration Information

Registration FormPlease fill out all required (*) fields. Incomplete forms cannot be submitted.

Registration Form
Please fill out all required (*) fields. Incomplete forms cannot be submitted.