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Student Last Name
Grade
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Mobile Number
Billing Address
E-mail
Contact Name and Number
Emergency Contact Name and Number
REGISTRATION FEES Summer is $10, Fall/Spring is $20 . For all pricing click the "FEES" tab
Please specify class and time please or private coaching
PROPER ATTIRE REQUIRED hudsonvalleydancewear.com
Payment Method
Billing First Name as on Credit Card
Billing Last Name as on Credit Card
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CV# (3 digit # on back of card)
Expiration Date
Waiver
Your full name as an (electronic signature) in agreement to the waiver above
Policies
Your full name as an (electronic signature) as to have read the HV Dance Policies above
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