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Welcome to
Philly's Got Dance

Ballet, Jazz, Hip Hop, Gymnastics & Tumbling

Contact Information

Philly's Got Dance

4305 Locust St

Philadelphia PA 19104

New Castle DE

Columbia SC

Aubrey TX

Phone: 267-304-0860

Email: phillysgotdance@gmail.com

pgdinternship@gmail.com

Hours of Operation

Tues - Fri 5pm-8pm

Sat: 11am-4pm

Pay tuition via links below or send Zelle payment to 267-304-0860

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Philly's Got Dance LLC

Student Registration Form

Registration date*

Month

Day

Year

Student's first name*

Student's last name*

Birth date*

Month

Day

Year

Age*

Nick name

Shirt size*

School name*

Grade*

Home address

Country/Region*

Address*

City*

Zip / Postal code*

Home phone number*

Parent/Guardian Information

Parent/Guardian 1 name*

Relationship to child 1*

Cell phone 1*

Work phone 1

Email 1*

Parent/Guardian 2 name

Relationship to child 2

Cell phone 2

Work phone 2

Email 2

Preferred way for receiving updates*

Text

Email

Authorized Pick-up Persons

Pick-up person 1 name*

Relationship to child*

Phone number*

Pick-up person 2 name

Relationship to child

Phone number

Pick-up person 3 name

Relationship to child

Phone number

Class Information

Program selection*

Payment Information

Payment plan*

Plan A: Payment on the 1st day of practice of every month

Plan B: Payment bi-weekly, due the 1st and 3rd week of class

All payments are due prior to the start of class

Registration fee*

New Student ($35)

Returning Student ($20)

Family ($50)

Payment Agreement

Person responsible for payment name*

Relationship to student*

I understand that there are no make-up class options currently available. I also understand that all fees paid are nonrefundable and nontransferable. There will be a $10 late fee charged PER week. There is a $30 returned check fee.

Emergency Information

Physician name*

Hospital preference*

Insurance company and policy number*

Allergies*

List any food, medicine, or other allergies

Additional medical information

Additional information/comments (i.e. blood transfusions, etc)

I authorize Philly’s Got Dance staff to seek emergency medical care for my child if I cannot be reached.

Parent/Guardian signature*

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Additional Information

How did you hear about our studio?*

Referral parent and child name

If you were referred, please provide the parent and child(ren) name

Previous dance experience*

Please list prior dance experience (number of years, technique studied, teachers, etc.)

Additional information about your child

Is there anything that we should know about your child? (e.g., allergies, shy, etc.)

PHILLY'S Got Dance LLC

4305 Locust St Philadelphia PA 19104

Serving children and families in West Philadelphia, University City, Columbia, South Carolina, Aubrey, Texas, and growing partner communities.

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