Last Name First Name
Mailing Address City State Zip
Birthdate Age Grade School
Years Taken at The Dance Place At Another School of Dance
Home Phone Cell Phone(s)
Mother's Name Phone (Daytime)
Father's Name Phone (Daytime)
Email Address(es)

Additional People who are allowed to pick up your child from dance:
Name Relationship to Child
Name Relationship to Child

My Child is interested in the following type(s) of dance classes:

Pay Registration Fee By:

For technical support, contact us at (803) 459-6651 or

Photography Credits: Jimmy Wood and Anthony Hawkesworth | Website by Katherine Dickinson