Phoenix Brazzel Empire Performance Art Company

Dance Program Registration

Confidence. Discipline. Expression. Excellence.

Welcome to Phoenix Brazzel Empire Performance Art Company!

We’re excited to welcome your dancer into a program designed to develop technique, confidence, discipline, creativity, and a genuine love for movement.

Please complete the registration form below. Once registration is complete, you’ll be directed to the appropriate payment page to secure your dancer’s enrollment.

Limited spots are available. Registration is not complete until payment has been received.

1. Parent / Guardian Information

Parent/Guardian Full Name

Preferred Method of Contact

2. Dancer Information

Dancer’s Full Name

Dancer’s Date of Birth

Does your dancer have previous dance experience?

If yes, please tell us about their dance background.

Include any styles studied, number of years dancing, previous studios/programs, performance experience, or anything else you would like the instructor to know.

What would you most like your dancer to gain from this program?

Stronger dance technique

Performance experience

Flexibility and mobility

Musicality and rhythm

Community and friendships

Preparation for future dance opportunities

4. Program Information

Your dancer will receive training in multiple dance techniques, including:

Modern • Contemporary • Ballet • J-Setting

Classes are organized by age group:

Ages 6–9: Thursday

Ages 10–12: Friday

Ages 13–18: Saturday

Program Hours: 3:00 PM–7:00 PM

Monthly Tuition

Ages 6–9 — $150/month

Ages 10–12 — $170/month

Ages 13–18 — $190/month

📍 Location529 SW 12th AvenueMiami, FL 33130

5. Health & Emergency Information

Emergency Contact Name

Relationship to Dancer

Emergency Contact Phone Number

Does your dancer have any allergies, injuries, medical conditions, physical limitations, or other circumstances the instructor should be aware of for safe participation?

If yes, please provide any information that is relevant to their participation in dance classes.

6. Photo & Video Permission

During classes, rehearsals, performances, and studio activities, photographs and video may be taken for promotional and educational purposes.

Do you give permission for your dancer to appear in photos and/or videos used by Phoenix Brazzel Empire Performance Art Company for its website, social media, advertising, and promotional materials?

Yes, I give permission.

No, I do not give permission.

7. Parent / Guardian Acknowledgment

Please review and acknowledge the following:

I understand that participation in dance and physical activity involves inherent risks of injury.

I have provided relevant information concerning my dancer’s ability to safely participate.

I understand that tuition is based on the program and age group selected.

I understand that registration is not considered complete until the required payment has been received.

I agree to follow the program’s policies regarding attendance, conduct, safety, and participation.

I understand that additional policies regarding tuition, refunds, missed classes, performances, costumes, and other program requirements may apply.

I have read and agree to the statements above.