On-Line Registration

 

Please complete and submit this form for each student you wish to register.

You will receive a confirmation email for your requested classes.

 

 

 

Parent(s)/Guardian(s) Name:

 

Billing Address:

 

Suite or Apt #:

 

City, St, Zip:

 

Email:

 

Home Phone:

 

Cell/Work Phone:

 

Student 1 Name:

 

Student 1 Date of Birth:

 

Student 1 Class Choices:

Class Name

Day

Time

1.  

 

 

2.  

 

 

3.  

 

 

4.  

 

 

5.  

 

 

Student 2 Name:

 

Student 2 Date of Birth:

 

Student 2 Class Choices:

Class Name

Day

Time

1.  

 

 

2.  

 

 

3.  

 

 

4.  

 

 

5.  

 

 

Student 3 Name:

 

Student 3 Date of Birth:

 

Student 3 Class Choices:

Class Name

Day

Time

1.  

 

 

2.  

 

 

3.  

 

 

4.  

 

 

5.  

 

 

 

Yes, I will pay in full online immediately after submitting this form.
No, I prefer to mail my payment to: 3rd Street Dance & Theatre Academy, Inc. 101 S         Third Street, St Charles, IL 60174

 

Comments or questions:

 

 

As with any physical activity there is a risk of injury. I agree that I will not hold 3rd Street Dance & Theatre Academy, Inc, or any faculty or instructor responsible for any injury to my child or children.

 

By submitting this form, you are stating that you understand and agree with the above disclaimer.