Request Form

Please complete all information on this form, and choose the dance class(es) that you are interested in. Each individual must fill out a Request Form. This is only a request; it does not guarantee placement. You will receive an e-mail within one week to either accept your request, or suggest another class if the class you requested is unavailable. Tuition, the registration fee and a registration form must be mailed to Premiere Dance Company, and then received by us within a week of your e-mail confirmation to reserve your child's place in class. Thank you!

Student First Name:

Student Last Name:

Student Age:

Student Birth Date:

Parent/Guardian First Name:

Parent/Guardian Last Name:

Home Phone:

E-Mail Address:

Please select your choice for Class 1:

Please select your choice for Class 2:

Please select your choice for Class 3:

NOTE: You may choose an older age category, if your child will be that age by November 1st. For example, choosing the 9-10 Poms dance class is allowed, if your child is now eight years old, but will turn nine years of age before November 1st.

Please provide additional comments or questions below.

Once you click on the submit button above, you will be directed to a confirmation page,

that reiterates each piece of information that you filled out on this form.

When you see the confirmation page, you can be assured that it was

received by PDC. If you are not directed to the confirmation

page, then please submit another request.

Thank you!

***CLASSES ARE SUBJECT TO CHANGE***

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Last updated on 08/16/2008