Student Name *

Please enter dancer's first and last name. Enter your own if you are a year-round adult student.

First Name

Last Name

Birth Date *

Enter dancer's date of birth.

MM

DD

YYYY

Parent/Guardian 1 Name *

*Year round adult students please resubmit your information here.

First Name

Last Name

Parent/Guardian 2 Name

First Name

Last Name

Parent/Guardian 1 Phone *

*Year round adult students please resubmit your information here.

(###)

###

####

Parent/Guardian 2 Phone

(###)

###

####

Emergency Contact Name *

Adult students please provide a different individual (ex. spouse or partner) to contact in case of injury. Do NOT resubmit your information.

First Name

Last Name

Emergency Contact Cell Phone *

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Studio Location *

Please pick a location to attend class.

Madison

Sun Prairie

Private Lessons

For dancers interested in a year round, regularly scheduled private lesson to focus on specific technical needs and/or learn a solo* for recital (or competition if on the MAD City dancers). The office will contact you about your interest and if there are open slots based on your availability. For drop-in privates, please schedule on our Pop-up/Drop-in page. *Solos may include additional costs.

Yes, I am interested.

Person to Bill (if different)

First Name

Last Name

Payments *

What payment plan do you prefer to be on? Please read our Payment Plan Options and Policies before selecting a plan.

Studio Run on the 1st of the month (Sept-May)

Studio Run on the 15th of the month (Sept-May)

Customer Run on the 1st of the month (Sept-May)

Customer Run on the 15th of the month (Sept-May)

Bi-weekly Studio Run (Sept-May)

Bi-weekly Customer Run (Sept-May)

Terms in Full (2 payments due Aug. 25th and Jan. 5th) Studio Run

Terms in Full (2 payments due Aug. 25th and Jan. 5th) Customer Run

Signature *

Signature accepting Statement of Understanding and agreeing to maintaining a valid credit card on file and authorizing payments on such card. Type your full name. 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 of Signature *

MM

DD

YYYY