Diggs School of Dance

Diggs School of Dance
PO Box 217
Topping, Virginia 23169
Phone: (804)694-5900
contact us by email

(Fields marked with are required!)*
Student's Name*
Date of Birth*
Age*
School*
Grade*
Parent's Name*
Address*
City/Zip*
Primary (Home or Cell) Phone Number*
Work Phone
Other Phone
e-mail address*
Account Billing Name*
May we use your child's photograph in promotional literature and our website?	Yes No
Classes Desired*:	Creative Movement PreBallet Ballet Adult Ballet Jazz Teen/Adult Jazz Modern Adult Modern Pilates
For New Students Only:
Previous dance training (years/classes)
Previous Teacher(s) Name
Name of previous dance studio(s) & location(s)
How did you learn about the studio?
Are other family members enrolled?	Yes No
Their Name(s)
I/We have read and understand the Studio's Policies and hereby agree to fully abide by these policies.
Type your full name here to serve as a legal signature*
Date*

Registration form must be returned before student may attend class.