Apply | Media Dance Ballet

Registration Form

First name

Last name

Birthday

Age

If age is under 18, put parent name here:

Home Phone

Cell

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Where did you study dance before? and for how long?

Where did you hear about us?

Emergency Contact

Emergency Phone

What class are you signning up for?

Pre Ballet (3~5 age)

Ballet

Jazz

Hip Hop

Please Read Policies Below:

Media City Dance classes are monthly and start at the beginning of each month. All tuition is due no later than the 5th of each month. A $15 late charge will be applied to all students and with no exceptions. A $30 service fee is applied to all returned checks. A $25 Registration fee is applied to all students for the year. Payments can be made as follows: Cash (exact change) Check, Zelle or Venmo. No credit cards accepted. Class and paid Online through Venmo: Natasha-Middleton-1 or for Zelle please call us for that information.

I agree to the terms & conditions

Thanks for applying!We’ll get back to you soon.