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Registration Form
Student:
E-mail:
Home #:
Questions or Comments:
Arabesque Academy of Dancing
"Personalized Dance Training From A 
Professional, Experienced, & Compassionate Staff"

Parent:
Address:
Student Birthday:
Cell #:
Credit Card #:
Credit Card Exp.:
Number of Classes:
Student Sizing:
Studio Location:
Please indicate studio location & class preferences below:

There is a $35 Registration Fee per student ($70 per family)
Payment Plan Option:
Payment Date
Security Code:
Tuition Option:

OneTwoThreeFourFiveSixSevenEight
Child SmallChild MediumChild LargeAdult SmallAdult MediumAdult LargeAdult XL
Elmhurst/Moscow Location
Scranton Location
Yes, I would like to use Auto-Pay!
No, I do not wish to use Auto-Pay.
I will Pay In Full! (Discounted Rate)
1st of the Month
15th of the Month
All-Inclusive Pricing (Costume Payment Is Included In Monthly Payment)
Per Class Pricing (Costumes Are Paid Separately)