Stage One Dance Center Class Registration

Stage One Dance Center Class Registration

Please provide the following contact information:
Parent's Name/Address:

First Name

Last Name

Street Address

City

State

Zip/Postal Code

Cell Phone

Other Phone

E-mail

Students Name:
First Name

Last Name

Date of Birth

Previous Experience

Enrollment Request/Class choice:

[Class 1 days/times]

[Class 2 days/times]

[Class 3 days/times]

[Class 4 days/times]

Registration $30 Required to hold your place in classes
Credit Card # (4 digits at a time, separated by dashes)

Cardholder Name

Visa, MC, Discover

Expiration Date

Verification Code

Today's date:

Whom may we thank for your referral?