Student's First Name
Student's Last Name
Student's Grade Level at time of Registration
Medical Conditions
Allergies
Home Number
Mobile Number
Billing Address
E-mail Address *required
Parent or Guardian Full Name and Number
Emergency Contact Full Name and Number and relationship
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 or MASTER CLASS
PROPER DANCE ATTIRE REQUIRED hudsonvalleydancewear.com
Payment Method
Billing First Name as on Credit Card
Billing Last Name as on Credit Card
Credit Card #
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
Comments