Online Registration

Online Registration Request Form

Please fill out the following form COMPLETELY and click SUBMIT.

Once we receive your registration request, we will call or send an email to the Primary Parent/Guardian (1) letting you know if we have availability in the class you request.
Each student will need their own form.

Student Information

* Indicates required field

Student Name *

First

Last

Phone Number (if any) *

Age *

Birthday *

Grade *

Health Concerns (if any) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Class Choice *

Preferred Time (primary) *

Secondary Class Choice *

Preferred Time (secondary) *

Does the student have previous dance experience?

Choose One: *

Yes No

How Did you hear about A Time To Dance? *

If YES, How many years taken, what classes/styles of dance, and studio name and location. *

Additional Comments *

Parent/Guardian Information

Parent/Guardian 1:

Name *

First

Last

Primary Phone Number *

Email *

Alternate Phone Number *

Parent/Guardian 2:

Name *

First

Last

Primary Phone Number *

Email *

Alternate Phone Number *

Emergency Contact (Other than Parents/Guardians)

Name *

First

Last

Primary Phone Number *

Email *

Alternate Phone Number *

Submit