Studio Location *

Madison

Sun Prairie

Student Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Parent/Guardian 1 Name *

Adult students please resubmit your information here.

First Name

Last Name

Parent/Guardian 2 Name

First Name

Last Name

Parent/Guardian 1 Phone *

Adult students please resubmit your information here.

(###)

###

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Parent/Guardian 2 Phone

(###)

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Emergency Contact Name *

Adult students please provide an individual to contact in case of injury. Do not resubmit your information.

First Name

Last Name

Emergency Contact Cell Phone *

(###)

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Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Person to Bill (if different)

First Name

Last Name

Classes *

Pre-Ballet (Ages 3 (Pre-School) 4 (4K)

Pre-Ballet II (Ages 5-6 - In Kindergarten)

Beginning Ballet (Ages 6 (1st grade) and up)

Ballet I (placement by instructor only)

Ballet II (placement by instructor only)

Ballet III (placement by instructor only)

Ballet IV (placement by instructor only)

Ballet V (placement by instructor only)

Ballet VI (Pre Pro by Invitation only)

Beginning Teen/Adult Ballet (13+)

Intermediate Teen/Adult Ballet (13+)

Advanced Teen/Adult Ballet (13+)

Beginning Tap (Ages 5 and up)

Tap I (placement by instructor only)

Tap II (placement by instructor only)

Tap III (placement by instructor only)

Tap IV (placement by instructor only)

Tap V (placement by instructor only)

Beginning Teen/Adult Tap (13+)

Intermediate Teen/Adult Tap (13+)

Jazz I (In Ballet 1 or placement by instructor only)

Jazz II (placement by instructor only)

Jazz III (placement by instructor only)

Jazz IV (placement by instructor only)

Jazz V (placement by instructor only)

Beginning Adult/Teen Jazz (13+)

Intermediate Adult/Teen Jazz (13+)

Beginning Hip Hop (Ages 5-7 and 8-10 year old beginningers))

Hip Hop 1 (Ages 8-12 and 13-14 year old beginners or by instructor)

Hip Hop 2 (Ages 13+ and up or by instructor)

Intermediate MAD City Comp Hip Hop (Audition)

Advanced MAD City Comp Hip Hop (Audition)

Conditioning (Fridays after Team HH ) (Ages 13+ and all MAD CITY DANCERS)

MAD City Mini Company (Audition)

MAD City Junior Company (Audition)

MAD City Teen Company (Audition)

MAD City Senior Company (Audition)

Private Lessons

Ballroom Classes (Couple or Group)

Boys Class (Ages 8-14)

Pilates Reformer

Modern III (Level III Ballet)

Modern IV (Level IV Ballet or placement by Instructor only)

Modern V (Level V Ballet or placement by Instructor only)

Selection of Payment Options *

Year in full within 3 business days of issue via cash, check or bank transfer via QuickBooks for a 3% discount.

9 Monthly payments via QuickBooks. Cards can be maintained on file for automatic payments

3 equal payments via QuickBooks. Due September, December and March 1st.

If Monthly Payments, Day of Month

1st

15th

Signature *

Signature accepting Statement of Understanding and authorizing automatic credit card payments if a payment plan is selected. Write name as it appears on the credit card. Call studio at 608-221-4535 to provide card number or stop in prior to first payment date to provide card information. Do not email.

First Name

Last Name

Date Signed *

MM

DD

YYYY

Name

First Name

Last Name