Name *

First Name

Last Name

Phone Number *

(###)

###

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How did hear about of us? *

Can check more than one box

I've registered my child in the past

My child's classmate/friend takes class at Koresh

Facebook

Instagram

Walking by

Flyer

Website

Another parent recommendation

I take class at the Koresh Adult School

Other

Student's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Class selection for the semester *

Modern Jazz

Modern

Ballet

Pointe

Hip Hop

GreenField Pick Up? *

We offer an afterschool pick-up service for Greenfield students taking dance classes at the Koresh School of Dance. Please note that there is a fee for this service.

Yes

No

Emergency Contact *

First Name

Last Name

Phone Number *

(###)

###

####

Media release *

I grant permission to Koresh Dance Company to take photographs and video of my child and use those images for the promotion of the Koresh School of Dance and the Koresh Youth Ensemble. I authorize the use of the photographs for the purposes of publicizing and promoting the Koresh School of Dance. I also authorize the reproduction and non-commercial distribution of photos and videos. I release the Company and its agents or employees thereof from any privacy, defamation or other claims I may have arising out of promotion of the Koresh Dance Company.

Yes, I grant permission for photos and videos to be taken.

No, I do not grant permission for photos and videos to be taken

Terms & Conditions *

By submitting this registration form, you acknowledge that you have read and understand all school policies and agree to their terms and conditions. By submitting this, you understand that you will not receive a refund by any means. Koresh does not offer make up classes for any classes missed. Tuition must be paid in full be the time of registration.

Yes, I agree to the Term & Conditions.