Registration Form

Registration Information

Fall Registration Information

For your convenience we now accept on-line registrations. 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 (for two classes, please fill out the form once and submit it, then fill it out again and submit).

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.

Student Name *

First

Last

Birthdate (mm/dd/yyyy) *

Age *

Parents 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.