REGISTRATION FORM

Registration Form

After your submission, we will email or call you to confirm registration. If you do not hear from us in 2 business days, please send an email to [email protected] Thank you!

Registration Form Information
Please be aware: By filling out the "Registration Form," you are committing to the classes you select as well the Registration fee and all class fees. If you would like more information or have questions you'd like to discuss before registering, please call or email us first--we are happy to help prior to you completing your registration form! It takes quite a bit of time to set up student accounts in our system each year; we appreciate your understanding!
"Wait List" Information
Due to the size of our studio rooms, our class sizes are limited. If a class you are interested in is listed as "wait listed" below, and no other class time works for your family, please call us at (336) 579-7812 or email [email protected] to discuss options or be added to the wait list. Thank you!
General/Contact Information
Address*
Street Address Address Line 2 City State ZIP Code
Primary Parent/Guardian*
First Last
Primary Parent/Gaurdian Phone*
Primary Parent/Gaurdian Email*
Secondary Parent/Guardian Name
First Last
Secondary Parent/Gaurdian Phone
Secondary Parent/Gaurdian Email
Please add Secondary Parent to:
Emergency Contact Name and Number (If primary and secondary cannot be reached)*
How Did You Hear About Us?
Payment Information
Preferred Payment Method*
- ACH Withdrawals
- Square/credit card invoices
Return ACH Accounts: You do not need to give us your bank info again if your banking info has not changed. ACH drafts are schedule for the 5th of each month Square invoices include a small fee. Invoiced are sent on the 1st and due on the 10th, after which a $15 late fee will be applied. ***IF selecting Square, skip to Student Info/Class Selection section***
Square Invoices: Please enter the email address you would prefer invoices to be sent:
Return Students: If you selected "ACH" has your banking info changed?
- YES: Fill out bank info
- NO: Skip bank info sectoin
If not, you do not need to give us your bank info again.
ACH/Banking Information: Depository Bank Name, Branch, City/State
ACH/Banking Information: Account Holder(s) Name(s)
ACH/Banking Information: Transit/ABA Number
ACH/Banking Information: Account Number
Student Information/Class Selections
First Student Name*
First Last
Age as of 8/1/2024*
Date of Birth*
T-shirt Size*

Youth XS-Adult XL
Does dancer have any allergies (severity?), injuries, or anything else you would like to disclose so we can provide the safest environment possible for your dancer?
SUMMER Desired Camps & Classes*
- Skip this section
- Creative Movement (Ages 2.5-4)
- Tiny Tumblers (Ages 3.5-5)
- Foundations (Ballet + Tap/ Ages 4.5-6)
- Ballet/Tap 1 + Fancy Flippers (Ages 5.5-7)
- Beginner Hip Hop (Levels 2 and 3 / Ages 7.5+)
- Beginner Ballet (Levels 2 and 3 / Ages 7.5+)
- Beginner Jazz/Modern (Levels 2 and 3 / Ages 7.5+)
- Turns, Leaps & Conditioning (Levels 2 and 3 / Ages 7.5+)
- Improvisation & Choreography Composition (Levels 2 & 3)
- Beginner Dance Team Choreography Camp- Grasshopper Game Performance (Levels 2 & 3)
- Intermediate Ballet (Level 4; 2 classes per week)
- Intermediate Hip Hop (Level 4)
- Intermediate & Advanced Jazz + Modern (Levels 4-6)
- Intermediate & Advanced Tap (Levels 4-6)
- Turns, Leaps, Conditioning (Levels 4-6)
- Improvisation & Choreography Composition (Levels 4-6)
- Intermediate/ Advanced Dance Team Choreography Camp
- Advanced Hip Hop (Levels 5-6)
- Advanced Ballet: Level 5 (2 classes per week)
- Beginner Pointe (New and Current Pointe Dancers)
- Advanced Ballet: Level 6 (2 classes per week)
Due to the size of our studio rooms, our class sizes are limited. If a class you are interested in is listed as "wait listed" below, please call us at (336) 579-7812 or email [email protected] to discuss options or be added to the wait list. Thank you! Current Wait Lists: None
FALL-SPRING Desired Class(es)*
- Skip this section
- Creative Movement (Ages 2.5-4)
- First Steps (Ages 2.5-4)
- Tiny Tumblers (Ages 3.5-5)
- Foundations (Ages 4-5, Ballet/ Tap)
- Ballet/Tap 1 (Ages 5.5-7)
- Fancy Flippers--previously "Intro to Acro" (Level 1, Ages 5.5-7)
- Beginner Hip Hop (Levels 1-3 or Ages 5.5-9)
- Ballet 2 (Beginner Level, Ages 7.5+)
- Ballet 3 (High Beginner)
- Jazz/Modern 2 & 3 (Beginner Level, Ages 7.5+)
- Tap 2 & 3 (Beginner Level, Ages 7.5+)
- Dance Team (Levels 2-3, Ages 7.5+)
- Turns, Leaps & Conditioning (Levels 2-3)
- Ballet 4 (Intermediate) 2 classes per week
- Modern/Jazz 4 (Intermediate)
- Intermediate Hip Hop (Level 4 or Ages 10-12)
- Intermediate / Advanced Tap (Levels 4-6)
- Turns, Leaps, & Conditioning (Levels 4-6)
- Dance Team (Levels 4-6)
- Ballet 5 (Advanced) 3 classes per week
- Ballet 6 (Advanced) 3 classes per week
- Modern 5 & 6
- Jazz 5 & 6
- Advanced Hip Hop (Levels 5 & 6 or Ages 13+)
- Show 2 Production: Invitation Only
Due to the size of our studio rooms, our class sizes are limited. If a class you are interested in is listed as "wait listed" below, please call us at (336) 579-7812 or email [email protected] to discuss options or be added to the wait list. Thank you! Current Wait Lists: None
Sibling/Student 2
Age as of 8/1/2024
Date of Birth
T-shirt Size

Youth XS-Adult XL
Does dancer have any allergies (severity?), injuries, or anything else you would like to disclose so we can provide the safest environment possible for your dancer?
SUMMER Desired Camps & Classes
- Skip this section
- Creative Movement (Ages 2.5-4)
- Tiny Tumblers (Ages 3.5-5)
- Foundations (Ballet + Tap/ Ages 4.5-6)
- Ballet/Tap 1 + Fancy Flippers (Ages 5.5-7)
- Beginner Ballet (Levels 2 and 3 / Ages 7.5+)
- Beginner Jazz/Modern (Levels 2 and 3 / Ages 7.5+)
- Turns, Leaps & Conditioning (Levels 2 and 3 / Ages 7.5+)
- Improvisation & Choreography Composition (Levels 2 & 3)
- Beginner Hip Hop (Levels 2 and 3 / Ages 7.5+)
- Beginner Dance Team Choreography Camp- Grasshopper Game Performance (Levels 2 & 3)
- Intermediate Ballet (Level 4; 2 classes per week)
- Intermediate Hip Hop (Level 4)
- Intermediate & Advanced Jazz + Modern (Levels 4-6)
- Intermediate & Advanced Tap (Levels 4-6)
- Turns, Leaps, Conditioning (Levels 4-6)
- Improvisation & Choreography Composition (Levels 4-6)
- Intermediate/ Advanced Dance Team Choreography Camp
- Advanced Hip Hop (Levels 5-6)
- Advanced Ballet: Level 5 (2 classes per week)
- Beginner Pointe (New and Current Pointe Dancers)
- Advanced Ballet: Level 6 (2 classes per week)
Due to the size of our studio rooms, our class sizes are limited. If a class you are interested in is listed as "wait listed" below, please call us at (336) 579-7812 or email [email protected] to discuss options or be added to the wait list. Thank you! Current Wait Lists: None
FALL-SPRING Desired Class(es)
- Skip this section
- Creative Movement (Ages 2.5-4)
- First Steps (Ages 2.5-4)
- Tiny Tumblers (Ages 3.5-5)
- Foundations (Ages 4-5, Ballet/ Tap)
- Ballet/Tap 1 (Ages 5.5-7)
- Fancy Flippers--previously "Intro to Acro" (Level 1, Ages 5.5-7)
- Beginner Hip Hop (Levels 1-3 or Ages 5.5-9)
- Ballet 2 (Beginner Level, Ages 7.5+)
- Ballet 3 (High Beginner)
- Jazz/Modern 2 & 3 (Beginner Level, Ages 7.5+)
- Tap 2 & 3 (Beginner Level, Ages 7.5+)
- Dance Team (Levels 2-3, Ages 7.5+)
- Turns, Leaps & Conditioning (Levels 2-3)
- Ballet 4 (Intermediate) 2 classes per week
- Modern/Jazz 4 (Intermediate)
- Intermediate Hip Hop (Level 4 or Ages 10-12)
- Intermediate / Advanced Tap (Levels 4-6)
- Turns, Leaps, & Conditioning (Levels 4-6)
- Dance Team (Levels 4-6)
- Ballet 5 (Advanced) 3 classes per week
- Ballet 6 (Advanced) 3 classes per week
- Modern 5 & 6
- Jazz 5 & 6
- Advanced Hip Hop (Levels 5 & 6 or Ages 13+)
- Show 2 Production: Invitation Only
Due to the size of our studio rooms, our class sizes are limited. If a class you are interested in is listed as "wait listed" below, please call us at (336) 579-7812 or email [email protected] to discuss options or be added to the wait list. Thank you! Current Wait Lists: None
Sibling/Student 3
Age as of 8/1/2024
Date of Birth
T-shirt Size

Youth XS-Adult XL
Does dancer have any allergies (severity?), injuries, or anything else you would like to disclose so we can provide the safest environment possible for your dancer?
SUMMER Desired Camps & Classes
- Skip this section
- Creative Movement (Ages 2.5-4)
- Tiny Tumblers (Ages 3.5-5)
- Foundations (Ballet + Tap/ Ages 4.5-6)
- Ballet/Tap 1 + Fancy Flippers (Ages 5.5-7)
- Beginner Ballet (Levels 2 and 3 / Ages 7.5+)
- Beginner Jazz/Modern (Levels 2 and 3 / Ages 7.5+)
- Turns, Leaps & Conditioning (Levels 2 and 3 / Ages 7.5+)
- Improvisation & Choreography Composition (Levels 2 & 3)
- Beginner Hip Hop (Levels 2 and 3 / Ages 7.5+)
- Beginner Dance Team Choreography Camp- Grasshopper Game Performance (Levels 2 & 3)
- Intermediate Ballet (Level 4; 2 classes per week)
- Intermediate Hip Hop (Level 4)
- Intermediate & Advanced Jazz + Modern (Levels 4-6)
- Intermediate & Advanced Tap (Levels 4-6)
- Turns, Leaps, Conditioning (Levels 4-6)
- Improvisation & Choreography Composition (Levels 4-6)
- Intermediate/ Advanced Dance Team Choreography Camp
- Advanced Hip Hop (Levels 5-6)
- Advanced Ballet: Level 5 (2 classes per week)
- Beginner Pointe (New and Current Pointe Dancers)
- Advanced Ballet: Level 6 (2 classes per week)
Due to the size of our studio rooms, our class sizes are limited. If a class you are interested in is listed as "wait listed" below, please call us at (336) 579-7812 or email [email protected] to discuss options or be added to the wait list. Thank you! Current Wait Lists: None
FALL-SPRING Desired Class(es)
- Skip this section
- Creative Movement (Ages 2.5-4)
- First Steps (Ages 2.5-4)
- Tiny Tumblers (Ages 3.5-5)
- Foundations (Ages 4-5, Ballet/ Tap)
- Ballet/Tap 1 (Ages 5.5-7)
- Fancy Flippers--previously "Intro to Acro" (Level 1, Ages 5.5-7)
- Beginner Hip Hop (Levels 1-3 or Ages 5.5-9)
- Ballet 2 (Beginner Level, Ages 7.5+)
- Ballet 3 (High Beginner)
- Jazz/Modern 2 & 3 (Beginner Level, Ages 7.5+)
- Tap 2 & 3 (Beginner Level, Ages 7.5+)
- Dance Team (Levels 2-3, Ages 7.5+)
- Turns, Leaps & Conditioning (Levels 2-3)
- Ballet 4 (Intermediate) 2 classes per week
- Modern/Jazz 4 (Intermediate)
- Intermediate Hip Hop (Level 4 or Ages 10-12)
- Intermediate / Advanced Tap (Levels 4-6)
- Turns, Leaps, & Conditioning (Levels 4-6)
- Dance Team (Levels 4-6)
- Ballet 5 (Advanced) 3 classes per week
- Ballet 6 (Advanced) 3 classes per week
- Modern 5 & 6
- Jazz 5 & 6
- Advanced Hip Hop (Levels 5 & 6 or Ages 13+)
- Show 2 Production: Invitation Only
Due to the size of our studio rooms, our class sizes are limited. If a class you are interested in is listed as "wait listed" below, please call us at (336) 579-7812 or email [email protected] to discuss options or be added to the wait list. Thank you! Current Wait Lists: None
Notes
Acknowledgement & Agreement of Registraion Process*
By entering my electronic signature, I am indicating: I am signing up aforementioned Student(s) for SESD's program. I understand the Registration Fee must be paid before Student's registration process can be completed. I understand that Student's registration will be fully processed and Student's spot will be held in the program after I submit payment for Registration fee. I understand the Registration Fee is not refundable.
Acknowledgement & Agreement of SESD Policies & Expectations*
• By signing below, I verify that all information I provided is thorough and true. I understand I am committing to the classes I've selected and all fees (and that all fees are non-refundable). • I acknowledge that I have read, understand, and agree to comply with all of the terms, procedures, policies including tuition and applicable fees, studio/lobby and classroom etiquette (in regards to students as well as parents/guests), dress code expectations, withdrawal procedures and fees, cancellation policy, as well as due dates and all other policies afore mentioned in this document as well as se-dance.com. • I agree to make payments at the designated time and agree to any late fees according to SESD policy. *If signed up for ACH withdrawals, I give SESD permission to withdraw agreed upon amount for the full season, unless written notice of student withdrawal is presented to and accepted by SESD/director. • I understand that Tuition, Registration, Showcase and Costume fees, and any other payments are non-refundable. • I understand that students are expected to attend each week in order to be promoted, participate in recital and performances, etc. Missed classes can be made up; however, SESD can never deduct from tuition payments. • I give my permission for SESD to use any and all photos and/or videos of said student in various media including but not limited to web images and various forms of advertisement. • Parent/guardian of minor or above student recognizes the existence of personal injury in said course of instruction and that they are assuming the risk without liability to Creative N’rgy INC. DBA Southeast School of Dance. • By signing below, I commit to the aforementioned season and realize that failure to comply with any of the above policies may result in consequences including dismissal from Southeast School of Dance.
Today's Date*
MM slash DD slash YYYY

Registration Form

Registration Form Information

"Wait List" Information

General/Contact Information

Payment Information

Student Information/Class Selections