REGISTER

MOHAWK VALLEY DANCE THEATRE

2021-2022 Registration Request Form

Please complete this form to request placement in class(es) for the season beginning September 13, 2021. All final placement decisions are made by the director. Once this form is completed, you will be contacted by e-mail to finalize registration. If you have not received a contact e-mail or phone call within one week, please reach out to the studio at (518) 900-2789.

* Indicates required field

STUDENT INFORMATION

Name *

First

Last

D.O.B. *

Email *

Phone Number *

Do you wish to receive text alerts in the case of closings/inclement weather? *

Yes No

Address *

Line 1

Line 2

City

State

Zip Code

Country

Is the student currently registered and active at MVDT? *

Yes No

MVDT or CAPA Alumni? *

Check here if you are an alumni.

MVDT COMPANY MEMBER? *

Yes, 2021 Season Yes, a Previous Season No

Phone Number *

PARENT/GUARDIAN OR EMERGENCY CONTACT INFORMATION

parent/guardian #1 name *

First

Last

Email for #1 *

Phone Number #1 *

parent/guardian #2 name *

First

Last

Email for #2 *

Phone Number #2 *

Who else has permission to pick up the child? *

please check if student is 12 or older and is permitted leave the premises alone *

Yes No

Please note, due to COVID-19 restrictions, we are a drop-off only facility. Any students under age 12 must be picked up and dropped off by a parent or guardian at this time.

I agree to receiving marketing and promotional materials

Submit

MOHAWK VALLEY DANCE THEATRE

2021-2022 Registration Request Form

Mohawk Valley Dance Theatre