2020/2021 Registration Form 
(Fill out and submit)

(A REGISTRATION IS NOT COMPLETE WITHOUT $20.00 REGISTRATION FEE - 
Please use "Buy Now" button at bottom of this page to submit with PayPal)

Dancer's Name
Parent's Name(s)
Address
E-mail Address
Home Phone
work phone
Emergency Contact
Relationship & Phone Number
Age (as of 9/1/20)
Birthdate
Grade
Previous Dance Training (place & length of time)
Allergies or Medical Conditions
How did you choose us?  (check all that apply)
Comments
CHECK SUBJECTS YOU WILL BE TAKING: (indicate how many of each)
*Pointe students must have teacher recommendation and be enrolled in at least 3 ballet classes per week
*Lyrical students must be enrolled in at least two ballet and one jazz class per week

Monthly Tuition is $55.00 for first class; $25.00 for second class; $15.00 for each additional class

MONTHLY TUITION - $
Monthly payments payable by Cash, Check or Credit Card
High Performance Dance Center
"Turning Dreams Into Reality"
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After you click "Submit", return to this page and click "Buy Now" to submit your Registration Fee
Your spot will not be reserved without payment!!
If you receive an error after submitting, you can return to this page and just click "Buy Now" to submit payment (you do not have to resubmit the registration form)

**When your registration form has been submitted, please go to the "Covid-19" page and read the Covid Re-Opening page, watch the re-opening video and print and sign the "Waiver".  The Waiver can be e-mailed or returned with your child on their first day.
Upon initialing and submitting this form, I give permission for the above named child to participate in the dance program at High Performance Dance Center.  I understand the risk of injury or illness inherent in any dance program and agree to not hold High Performance Dance Center, Lisa Roth, her staff or heirs liable should any such injury or illness occur while participating in this dance program.
(initial here)
Day Care
Website
Friend/Relative (list name in comment section
Other (explain in comment section)
TAP
JAZZ
CLASSICAL BALLET
PRIMARY TAP/JAZZ COMBO (Ages 5-6)
POINTE*
LYRICAL*
KINDERDANCE (Ages 3-4)
HIP-HOP
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ACRO