Dancenter Salisbury Student Registration 2023-24

STUDENT NAME: *

PARENT/GUARDIAN NAME: *

STUDENTS DATE OF BIRTH: *

STREET ADDRESS: *

CITY, STATE, ZIP *

PREFERRED PHONE: *

EMAIL ADDRESS: *

FIRST CHOICE/DAY & TIME OF CLASS: (You may add more than one class)

SECOND CHOICE/DAY & TIME OF CLASS: (You may add more than one class) This choice will be used as a default in the event your first choice is full

REGISTRATION FEE ($20.00) PER FAMILY

PLEASE INCLUDE CREDIT CARD INFORMATION BELOW OR USE VENMO @dancenter

Credit Card #:

Expiration date:

CCV: *