REGISTER

MOHAWK VALLEY DANCE THEATRE

2019-2020 Season Student Online Registration Form

Please complete one form for each individual student. Once you have completed your registration, you will need to complete payment by using our payment page or through the studio, in person or by phone. Registration is not considered active until payment has been made in full.

* 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.

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

CLASS INFORMATION

Select all classes that apply. Students may select to take classes in both locations.

I agree to receiving marketing and promotional materials