Center Stage Dance Company
150 South Bostian Street
China Grove NC 28023 704-857-6312
Fall Registration 2012-2013
To register for fall classes which will begin on Monday, August 13, 2012, please complete the information below and return to the studio.  There is a $25 non-refundable registration fee to hold each student's place in class.  Please return your form and fee as soon as possible to obtain your place in class.  Class sizes are limited and are placed on a first come first serve basis.  You may return registration forms to the studio by dropping off in person, placing in the gold box in the lobby, mailing to address above, or dropping through our mailslot in the door on the right hand side of our building.  Confirmation of your registration will be mailed out the end of summer before classes begin.

Student Name______________________________________________________________________________

Mailing Address_____________________________________________________________________________

City____________________________________________________________   Zip________________________

Parent/Guardian______________________________________________________________________________

Home Phone___________________________________   Cell Phone_________________________________

Age______   Date Of Birth_____________________  School Attending________________________________

Previous Years of Experience ( if new with Center Stage)_____________

Email Address_______________________________________________________________________________

Class(es) Registering For:  (Please list age, class, subject, day, time)

____________________________________________________________________________________________

____________________________________________________________________________________________

Release Form
   I do hereby acknowledge and agree that participation in classes and performances with Center Stage Dance
Company will be solely at the risk of this applicant and I do release Center Stage Dance Company, director, and
instructors from all claims that might arise from the applicant's participation in the said program. 
   I do hereby acknowledge that I am in good general health and can particpate fully in classes and performances.

                     Student Name____________________________________________________________________

                     Parent/Guardian Signature__________________________________________________________

                     Date___________________________________________________

                                                      Enclosed registration fee of $25
                                  ____cash    ______check  _____Visa/Mastercard/Discover/American Express
Card #_______________________ ________________________________  Exp. Date____________ Billing Zip Code_____________
             We look forward to seeing you in August!