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Online Registration

Fall 2018

Fall 2018 Registration Form
Current Student New Student
First Name Last Name
Home ( ) - Work ( ) -
Cell ( ) - E-mail *REQUIRED
Student Information
Student First Name Student Last Name
Birth date School
Home Address City
State Zip
Please provide any pertinent medical or disability information for your student.

Class Selection
See our class schedule for more info. If uncertain, please submit questions and we will assist you.

Silver Swans
Silver Swans
(5 Week Session)

Tiny Tots and Jumping Jacks
Tiny Tots 5:00 Class
(age 2 w/ parent participation)
Tiny Tots 6:15 Class
(age 2 w/ parent participation)
Jumping Jacks - Tuesday
(age 3)
Jumping Jacks - Thursday
(age 3)

Pre Dance Classes
Pre-Dance 1 - Tuesday
(age 4-5)
Pre-Dance 1 - Thursday
(age 4-5)
Pre-Dance 2 - Wednesday
(age 4-5)
Pre-Dance 2 - Thursday
(age 4-5)

Elementary Classes
Elementary Dance 1 - Tuesday
(Grades 1-3)
Elementary Dance 1 - Wednesday
(Grades 1-3)
Elementary Dance 2/3 - Monday
(Grades 2-3 w/ exp)
Elementary Dance 2/3 - Thursday
(Grades 2-3 w/ exp)

Beginning Teen Ballet Lower Intermediate Ballet Intermediate Ballet 1
Intermediate Ballet 2 Intermediate Ballet 3 Advanced Ballet
(w/ teacher permission)

Contemporary 1 Contemporary 2 Adult Contemporary

Hip Hop
Beginning Hip Hop Boys Beginning Hip Hop Lower Intermediate Hip Hop
Intermediate Hip Hop 1 Intermediate Hip Hop 2 Intermediate Hip Hop 3
Advanced Hip Hop

Beginning Teen Jazz Lower Intermediate Jazz Intermediate Jazz 1
Intermediate Jazz 2 Intermediate Jazz 3 Advanced Jazz
Adult Jazz 1 Adult Jazz 2

Beginning Modern Intermediate Modern Advanced Modern

Lower Intermediate Tap Intermediate Tap 1 Intermediate Tap 2
Intermediate Tap 3 Advanced Tap Adult Tap 1
Adult Tap 2

Beginning Tumbling Intermediate Tumbling Advanced Tumbling

How did you hear about us?
Newspaper Riley Festival Booth Pensy Art Fair
Website Friend Other:


Please read through our studio waiver. Once finished, please check the box below to electronically sign the waiver for our studio records.
I have read through the waiver and agree to the terms and conditions listed.

You will receive an e-mail or phone call from the studio office to confirm your submission and answer your questions within 48 hours.
Once we have confirmed your registration you will receive another email with an invoice. This invoice can be paid online or in person at the studio.
Thank you for your interest in Wilkerson Dance Studio.