PLEASE PUT THE NAMES OF ALL YOUR DANCERS IN THE FIRST FIELD UNDER (NAME)

* Required fields
Name *
E-mail Address *
Address *
City *
State *
Zip Code *
Birthdate *
Age
Grade for this school year
Home Phone *
Work Phone *
Cell Phone *
Cell Phone Carrier (At&T, Verizon Sprint, T Mobile etc) *
Parents'/Guardian's Name(s): *
Auto Charge Enrollment (Mandatory): Card Holder's Name *
CARD NUMBER *
Expiration Date *
CVV CODE *
Billing Address for this card *
AUTO CHARGE Payments will be withdrawn from the 23rd to the 28th of the previous month for the month ahead. Tuition and costume payments will be withdrawn. *

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