Student(s)*Please click the + sign to add additional students that you're enrolling per family.First NameLast NameAgeBirthdayGenderPhone MaleFemale Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneEmail* Father's Name First Last Father's Cell PhoneFather's Occupation Mother's Name First Last Mother's PhoneFather's Occupation School Grade in School Has student had previous training?* Yes No Studio Name Years in TumblingYears in DanceDoes your student have any physical disabilities?* Yes No Does your student have any medical concerns?* Yes No If yes, please explain:How did you find us? Radio TV Newspaper Yellow Pages Friend Current Student Student/Class #1*NOTE: Classes are subject to change.Mon 4:30-5:15 Tap, Ballet & TumblingMon 5:15-6:00 Tap, Ballet & TumblingMon 5:15-6:00 Tiny Stars Gymnastics: Boys & GirlsMon 6:00-6:45 Tap, Jazz & TumblingMon 6:00-7:00 Stars Gymnastics: Boys & GirlsMon 6:45-7:30 Tap, Jazz, Tumbling - JuniorsMon 7:30-8:15 Tap, Jazz, Lyrical & Tumbling - TeenMon 8:15-9:00 Tap, Jazz, Lyrical & Tumbling - SeniorsTue 3:45-4:30 Pre-School: Tap, Ballet & TumblingTue 4:30-5:15 Tap, Jazz & TumblingTue 5:30-6:00 Mommy & Me: Tap, Ballet & TumblingTue 6:00-7:00 Starchaser Gymnastics: Boys & GirlsTue 7:00-8:30 Shooting StarsTue 6:00-6:45 Tap, Jazz & LyricalTue 6:45-7:30 Tap, Jazz & LyricalTue 7:30-8:30 Ballet: Technique OnlyTue 8:30-9:00 Pointe: Technique OnlyWed 4:30-5:15 Jazz & LyricalWed 5:15-6:00 Tap, Jazz, Ballet & TumblingWed 5:15-6:00 Twinkling Stars: Gymnastics; Boys & GirlsWed 6:00-6:45 Jazz & LyricalWed 6:00-7:30 Shooting Stars: Gymnastics Tumbling Team Power StarsWed 6:45-7:30 Technique ClassWed 7:30-8:15 Adult Hip Hop ClassWed 8:15-9:00 Adult Jazz & LyricalThu 3:30-4:15 Hip HopThu 4:15-5:00 Tap, Ballet & TumblingThu 5:00-6:00 Starbursts Gymnastics: Boys & GirlsThu 5:15-6:00 Tap, Ballet & TumblingThu 6:00-6:45 Tap, Ballet & TumblingThu 6:00-7:00 Starpower Gymnastics: Boys & GirlsThu 6:45-7:30 Hip HopThu 7:30-8:30 Competitive Class - Small Group - JuniorThu 8:30-9:30 Competitive Class - Small Group - SeniorFri 4:00-4:45 Beginners BalletFri 4:45-5:30 Ballet ClassFri 5:30-6:00 Pointe ClassFri 5:00-6:30 Pointe Class: Power Stars Work Out ClassStudent/Class #2*NOTE: Classes are subject to change.Mon 4:30-5:15 Tap, Ballet & TumblingMon 5:15-6:00 Tap, Ballet & TumblingMon 5:15-6:00 Tiny Stars Gymnastics: Boys & GirlsMon 6:00-6:45 Tap, Jazz & TumblingMon 6:00-7:00 Stars Gymnastics: Boys & GirlsMon 6:45-7:30 Tap, Jazz, Tumbling - JuniorsMon 7:30-8:15 Tap, Jazz, Lyrical & Tumbling - TeenMon 8:15-9:00 Tap, Jazz, Lyrical & Tumbling - SeniorsTue 3:45-4:30 Pre-School: Tap, Ballet & TumblingTue 4:30-5:15 Tap, Jazz & TumblingTue 5:30-6:00 Mommy & Me: Tap, Ballet & TumblingTue 6:00-7:00 Starchaser Gymnastics: Boys & GirlsTue 7:00-8:30 Shooting StarsTue 6:00-6:45 Tap, Jazz & LyricalTue 6:45-7:30 Tap, Jazz & LyricalTue 7:30-8:30 Ballet: Technique OnlyTue 8:30-9:00 Pointe: Technique OnlyWed 4:30-5:15 Jazz & LyricalWed 5:15-6:00 Tap, Jazz, Ballet & TumblingWed 5:15-6:00 Twinkling Stars: Gymnastics; Boys & GirlsWed 6:00-6:45 Jazz & LyricalWed 6:00-7:30 Shooting Stars: Gymnastics Tumbling Team Power StarsWed 6:45-7:30 Technique ClassWed 7:30-8:15 Adult Hip Hop ClassWed 8:15-9:00 Adult Jazz & LyricalThu 3:30-4:15 Hip HopThu 4:15-5:00 Tap, Ballet & TumblingThu 5:00-6:00 Starbursts Gymnastics: Boys & GirlsThu 5:15-6:00 Tap, Ballet & TumblingThu 6:00-6:45 Tap, Ballet & TumblingThu 6:00-7:00 Starpower Gymnastics: Boys & GirlsThu 6:45-7:30 Hip HopThu 7:30-8:30 Competitive Class - Small Group - JuniorThu 8:30-9:30 Competitive Class - Small Group - SeniorFri 4:00-4:45 Beginners BalletFri 4:45-5:30 Ballet ClassFri 5:30-6:00 Pointe ClassFri 5:00-6:30 Pointe Class: Power Stars Work Out ClassStudent/Class #3*NOTE: Classes are subject to change.Mon 4:30-5:15 Tap, Ballet & TumblingMon 5:15-6:00 Tap, Ballet & TumblingMon 5:15-6:00 Tiny Stars Gymnastics: Boys & GirlsMon 6:00-6:45 Tap, Jazz & TumblingMon 6:00-7:00 Stars Gymnastics: Boys & GirlsMon 6:45-7:30 Tap, Jazz, Tumbling - JuniorsMon 7:30-8:15 Tap, Jazz, Lyrical & Tumbling - TeenMon 8:15-9:00 Tap, Jazz, Lyrical & Tumbling - SeniorsTue 3:45-4:30 Pre-School: Tap, Ballet & TumblingTue 4:30-5:15 Tap, Jazz & TumblingTue 5:30-6:00 Mommy & Me: Tap, Ballet & TumblingTue 6:00-7:00 Starchaser Gymnastics: Boys & GirlsTue 7:00-8:30 Shooting StarsTue 6:00-6:45 Tap, Jazz & LyricalTue 6:45-7:30 Tap, Jazz & LyricalTue 7:30-8:30 Ballet: Technique OnlyTue 8:30-9:00 Pointe: Technique OnlyWed 4:30-5:15 Jazz & LyricalWed 5:15-6:00 Tap, Jazz, Ballet & TumblingWed 5:15-6:00 Twinkling Stars: Gymnastics; Boys & GirlsWed 6:00-6:45 Jazz & LyricalWed 6:00-7:30 Shooting Stars: Gymnastics Tumbling Team Power StarsWed 6:45-7:30 Technique ClassWed 7:30-8:15 Adult Hip Hop ClassWed 8:15-9:00 Adult Jazz & LyricalThu 3:30-4:15 Hip HopThu 4:15-5:00 Tap, Ballet & TumblingThu 5:00-6:00 Starbursts Gymnastics: Boys & GirlsThu 5:15-6:00 Tap, Ballet & TumblingThu 6:00-6:45 Tap, Ballet & TumblingThu 6:00-7:00 Starpower Gymnastics: Boys & GirlsThu 6:45-7:30 Hip HopThu 7:30-8:30 Competitive Class - Small Group - JuniorThu 8:30-9:30 Competitive Class - Small Group - SeniorFri 4:00-4:45 Beginners BalletFri 4:45-5:30 Ballet ClassFri 5:30-6:00 Pointe ClassFri 5:00-6:30 Pointe Class: Power Stars Work Out ClassStudent/Class #4*NOTE: Classes are subject to change.Mon 4:30-5:15 Tap, Ballet & TumblingMon 5:15-6:00 Tap, Ballet & TumblingMon 5:15-6:00 Tiny Stars Gymnastics: Boys & GirlsMon 6:00-6:45 Tap, Jazz & TumblingMon 6:00-7:00 Stars Gymnastics: Boys & GirlsMon 6:45-7:30 Tap, Jazz, Tumbling - JuniorsMon 7:30-8:15 Tap, Jazz, Lyrical & Tumbling - TeenMon 8:15-9:00 Tap, Jazz, Lyrical & Tumbling - SeniorsTue 3:45-4:30 Pre-School: Tap, Ballet & TumblingTue 4:30-5:15 Tap, Jazz & TumblingTue 5:30-6:00 Mommy & Me: Tap, Ballet & TumblingTue 6:00-7:00 Starchaser Gymnastics: Boys & GirlsTue 7:00-8:30 Shooting StarsTue 6:00-6:45 Tap, Jazz & LyricalTue 6:45-7:30 Tap, Jazz & LyricalTue 7:30-8:30 Ballet: Technique OnlyTue 8:30-9:00 Pointe: Technique OnlyWed 4:30-5:15 Jazz & LyricalWed 5:15-6:00 Tap, Jazz, Ballet & TumblingWed 5:15-6:00 Twinkling Stars: Gymnastics; Boys & GirlsWed 6:00-6:45 Jazz & LyricalWed 6:00-7:30 Shooting Stars: Gymnastics Tumbling Team Power StarsWed 6:45-7:30 Technique ClassWed 7:30-8:15 Adult Hip Hop ClassWed 8:15-9:00 Adult Jazz & LyricalThu 3:30-4:15 Hip HopThu 4:15-5:00 Tap, Ballet & TumblingThu 5:00-6:00 Starbursts Gymnastics: Boys & GirlsThu 5:15-6:00 Tap, Ballet & TumblingThu 6:00-6:45 Tap, Ballet & TumblingThu 6:00-7:00 Starpower Gymnastics: Boys & GirlsThu 6:45-7:30 Hip HopThu 7:30-8:30 Competitive Class - Small Group - JuniorThu 8:30-9:30 Competitive Class - Small Group - SeniorFri 4:00-4:45 Beginners BalletFri 4:45-5:30 Ballet ClassFri 5:30-6:00 Pointe ClassFri 5:00-6:30 Pointe Class: Power Stars Work Out ClassEnrollment Fee Price: Total $0.00 Product NamePLEASE READ Lesson fees are paid monthly. I understand that lessons are due in advance the 1st day of the month and that lesson fees paid after the 7th of the month will be assessed a late payment fee of $10. Your child’s lesson is reserved for you. You will be charged for lessons until we are notified by you that your child will not attend. Let us know if you are paying for someone else. All costume fees for dancers and gymnastic students of $85, for each routine in the concert, are due on October 1st. (Does not apply to gymnastic teams or competition dance.) All of our students have enjoyed performing in our annual concert which is usually held the last of May or early June. Information will be given to you later. Students in the concert pay $40 in March. This entitles each student’s family and friends to see the concert free. All students are required to be in the concert. The concert is a great experience and fun to perform for an audience. I understand, as a parent or guardian, that any activity involving motion, rotation or height creates the possibility of injury including slight to serious. I attest and verify that I have full knowledge of the risks involved in these lessons, and I give permission to seek medical help if needed. I have also received and read the information booklet about the school. In consideration of the acceptance of this application for registration, I, intending to be legally bound hereby for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against the Hollingsworth School of Dance and Gymnastics or its representatives and/or assignees, for any and all damages which may be sustained and suffered by my child named on the above form, in connection with association with or entry in this school and which may arise out of traveling to, participating in, or returning from the school. I understand that the school does not provide medical insurance and no refunds on costumes and supplies after ordered. Private lessons no refunds. Lesson refunds by approval of owner. I understand that lessons will stop if over 30 days past due. Payments 60 days past due go to collections.Parent/Guardian Signature*PAYPAL Please note: payment is collected using the PayPal processor. After you click "Add to Cart" below and complete the details on the checkout page, you will be redirected to PayPal's website to complete the order and enter your payment information. If you don't have a PayPal account, please click the "Pay with Debit or Credit Card" button as shown in the graphic. Subtotal Options Total Enrollment quantity Add to cart Category: Uncategorized Related products Pay Select options [divider] On July 29, 2020 / [divider]