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Pom Pom Registration Form
Registration is not complete until you have submitted full payment for the class.
You may mail payment to
320A Central Avenue - Butner, NC 27509
or drop payment in the lock box outside the studio.
*
Indicates required field
Student Name
*
First
Last
Student Age
*
Student Birthday
*
Parent Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Please enter the number that you can be reached at quickly. Preferably a cell phone number.
Email
*
Please list any medical concerns I should know about this student.
*
Pom Pom classes are from 6pm - 7pm on Tuesdays and Thursdays on May 19th - May 28th. (4 classes in total)
*
I understand that Pom Pom classes are held on the dates listed above and the price per student is $50 payable in advance.
Princess Dance Camp is $25 per dancer/per camp.
Media Release Statement. I hereby consent that photographs and videos taken of my child during class may be used by Melissa and / or Melissa's School of Dance for use on our web sites and / or for promotional material. Names of students will not be published.
*
Yes
No
Melissa's School of Dance does not carry medical insurance for its students. It is required that all students be covered by their own family insurance policies and if any injury occurs it is understood that the student's own policy is your only source of reimbursement.
*
By checking here, I have read and agree to follow all policies that are listed on this website and that are posted in the studio.
Submit
Home
Studio Info
Location & Contact Info
Classes
Dance calendar
Studio Policies
>
Tuition
Attendance
3 "A's" of Dance
Attire
Class times
Make-up classes
Other policies
Class schedule
MSOD Dance Opportunities
Disney World Holiday Trip
Dance Convention 2021
Register Now
Parent Portal
Wedding Choreography
Showcase Program Ads
Spring Session