Dancer's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

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Phone

(###)

###

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Registration Fee - fees are payable upon registration and are refundable up until Sept. 17th, less a $50 admin fee.

Registration Fee $750 - to be applied in 3 equal payments ($250 per dance term)

Registration Fee $1950 + 10% Discount - to be applied in 3 equal payments ($650 per term) adds a 10% discount on class fees for the season.

Method of Payment

Please charge CC on file.

Please call me for CC info.

I will etransfer info@fayez1danceacademy.com