Online Registration

Darien School Of Dance LLC at the YWCA Darien/Norwalk
Registration/Waiver Form: Please Fill Out Completely
Student's Name:*
Age:*
Grade:*
Birth Date:*
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Address:*
Cell Phone:*
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Home Phone:
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E-mail:*
Parent's Name:*
Any medical/concerns:
Registration and Payment Policy:
Agreement for Participation:
Parent’s signature (required):
Once a week class:
Day:
Time:
Twice a week/2nd & 3d class of lesser price, 20% discount:
Day1:
Time1:
Day2:
Time2:
Session I (Sept 11 -Dec 23) 15(wks):
Session II (Jan 8 – May 26) (18 weeks):
Session I and Session II (33wks):
Registration fee:*
Total: