Dance School » Registration Form

This registration form is for students who wish to take classes regularly. If you wish to take single classes, you do not need to register. Registering adds the benefits of receiving special pricing for dance classes as well as the opportunity to enroll in school programs. The cost of Annual Registration is $35. For information on related fees, please see our Class Fees page.

Please fill out the following form to register online. Registration forms are also available at the front desk at the dance studio.

*Required information

Registering for*  Regular Session Summer Session
Today's Date
Student Information
Student's First/Last Name*
Student's Address*
Student's Home Phone*
Student's Cell Phone
Student's E-mail
Student's Gender is*	Male Female
Student's Birthdate*
Student's Age*
Student's years of prior dance training, what styles?
What is student's #1 reason for taking dance?
Parent/Guardian Information If student is age 18+, this section may be left blank.
Parent/Guardian's First/Last Name*
Parent/Guardian's Relation to Student*
Parent/Guardian's Phone*
Parent/Guardian's E-mail*
Who is authorized to pick up student?*
Does student have permission to leave the premises for food or other reasons?*	Yes No
Emergency Contact Information
Emergency Contact's Name*
Emergency Contact's Relation to Student*
Emergency Contact's Phone*
Emergency Contact's E-mail*
Does student have health problems that we need to be aware of?*	Yes No
If yes, please explain
Payment Information
Payment Type*  Credit (We accept Visa, MasterCard, and American Express) Debit Check Cash We are able to process credit transactions over the phone (323-292-5852). If another Payment Type is selected, please complete your payment at the front desk at the Lula Washington Dance Theatre studio. Please call us if you have any questions.
E-mail to Send Verification to*