JUNE 17 - AUGUST 11, 2019 (closed July 1-5)



Prior to registration, please review our Class Descriptions, and please Contact Us with any questions.

Please complete a separate registration form for each student.

Student Name *
Student Name
Student Phone (optional for minors)
Student Phone (optional for minors)
Student Date of Birth *
Student Date of Birth
Is This Student *
Select your Class(es) *
Please use this area to let us know necessary information about your student's medical conditions, special needs, or anything else you feel it would be helpful to know!
Parent or Guardian Name *
Parent or Guardian Name
If Student is over 18 years of age, please write "void" in each box. Thanks!
Parent or Guardian Name
Parent or Guardian Name
Address *
Phone 1 *
Phone 1
Phone 2
Phone 2
How did you hear about us? *
Release and Authorization *
I, the student, parent or legal guardian of a student of Tye Chua Dance, for and in consideration of my enrollment or the enrollment of my child or a student for whom I have been granted legal custody hereby voluntarily and knowingly execute this release with the expressed intention of effecting the extinguishment of and complete release from any and all claims, actions, demands or rights to monetary judgment rising from any and all injury or physical harm which may arise from or be sustained as a result of my participation or the participation of my child and/or legal ward in various programs of instruction, practice and physical activity associated with the study of dance and related activities conducted by Tye Chua Dance. I give my permission for my child’s picture to appear on Tye Chua Dance promotional materials including on the website and in any publications or advertisements. The child’s name will not be published without additional permission. I have read and understand the Tye Chua Dance policies and agree to abide by these policies without exception.
Digital Signature of Student or Parent/Guardian *
Digital Signature of Student or Parent/Guardian
Date *