Online Registration

Please fill out a separate registration form FOR EACH STUDENT

**This year we will be utilizing email for registration, studio and class announcements. Please use an email address that would be best to contact you.

New or returning student

New Returning

Age

Birth Date

Name

Address

City

State

Zip

Information for Parent/Guardian #1

Information for Parent/Guardian #2

Information for Emergency Contact

Parent/Guardian Name

Parent/Guardian Name #2

Emergency Contact Name

Cell Phone Number

Emergency Contact Number

Other Phone Number

Select Your Desired Start Time

Earliest starting class time

4pm 4:30pm 5pm 5:30pm 6pm 6:30pm

Are you able to attend a Saturday class

Yes No

Are you able to attend a Friday class

Yes No

Are you able to attend a morning class on weekdays?

Yes No

Select The Classes You Are Interested In

Select your desired class(s)

Ballet/Tap Combo Class -ages 3 & up Ballet/Tap/Jazz Combo Class - ages 6 & up Pom Pon - ages 6 & up Hip Hop - ages 7 & up Leaps & Turns - ages 9 & up Pointe Prep - ages 11 & up Pointe - Teacher placement required Ballet Technique - 9 & up/Min. 4 years exp. necessary Modern Dance - ages 10 & up Musical Theater - ages 7 & up Adult Classes - Pending Enrollment Lyrical - ages 10 & up Contemporary - ages 10 & up/Teacher Placement req. Core Strengthening Class - ages 12 & up Okinawan Shorin Ryu Karate - ages 8 & up

Please enter any time/day conflicts you may have

Any other comments or suggestions regarding your child's class

New Students ONLY - Please list your previous dance experience.

Contact Information

618-628-0402
info@taylorsacademyofdance.com
715 Lakepointe Center Drive, O'Fallon, IL 62269