Fill out your information to join our classes.

Looking forward to seeing you soon In-Person or on Zoom!

1Student Information

2Class choices

3Final Questions and Register

Name *

First

Last

Birth Date *

Parent/Guardian Name (if Minor)

First

Last

Parent/Guardian Name 2 (if Minor)

First

Last

Email *

*You accept receiving e-mails about the classes you registered for.

Secondary Email

Primary Phone *

Secondary Phone

Emergency Contact Name

First

Last

Emergency Contact Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

County *

If Other:

Choose the classes you want to register for:

All classes are held In-Person or Zoom currently and FREE to all under 18!

Register for as many classes that you want to attend. Adults: $17.00 per class Seniors and Persons with Disabilities: $15.00 Under 18: FREE Zoom: FREE for ALL!! You will need to register for every class, as we have a limit of 8 people to social distance. This form allows us to know which classes you are interested in attending and adds you to the notifications.

Dancing Work Out

Dancing Work Out w/ Claire Porter (In-Person MWF - 9:30 AM - 11:00 AM)

Modern

Modern Dancercise w/ Elissa Adults-Seniors (In Person T 11:30 AM-12:30 PM)
Modern Dance w/ Elissa and guests(In-Person Sat 11:00 AM-12:30 PM)
Modern Dance teen-adults ( In Person Tue 7:30PM - 8:20PM)

Latin Fusion

Latin Fusion (Zoom) M 5:30-6:10 PM

Drop in and Dance

Ages 3-7 with Allison 4:30PM - 5:20PM
Ages 7-14 with Allison 5:30PM - 6:20PM

Yoga/Stretching

Gentle Yoga w/ Elissa (Zoom W 11:30 AM-12:10 PM)
Restorative Stretch and Movement w/ Katonya (Zoom Th 11:30 AM-12:10 PM)
Gentle Yoga w/ Elissa (In-Person Th 3:30 PM-4:20 PM)
TGIF Yoga w/ Silinea (Zoom F 5:30 PM-6:10 PM)

African Dance and Drum

Creative African Dance w Yahya Ages 4-12 (In-Person Th 4:30PM - 5:20PM)
Afro-Modern Company Ages w Yahya 12-21 (In-Person Th 5:30PM - 7:20PM)
African Dance and Drum w Yahya All Ages (Zoom Sun 2:00-3:00 PM)
African Dance and Drum w Yahya All Ages (In-Person Sun 2:00-3:00 PM)
Drumming w Yahya (In-person Sun 3:00 PM - 3:30PM)

Hip-Hop

Hip-Hop w/ Jayren (In-Person Th 7:30 PM-8:20 PM)

Moving Experience/Strive

"Strive" Adults w/ disabilities w/ Amanda (In-Person T 10:00 AM-10:50 AM)
Moving Experience Adults w/ Disabilities w/ Silinea and Amanda (In-Person T 6:30 PM-7:20 PM)
Moving Experience Adults w/ Disabilities w/ Silinea and Amanda (Zoom T 6:30 PM-7:20 PM)
Moving Experience Ages 10-20's w/ Disabilities w/ Kalena and Amanda (In-Person Sat 1:00 PM-2:00 PM)

Saturday Family Dance

Toddlers, siblings & parents Allison 10AM - 10:50AM

May we use yours or your child's photos or videos for publicity purposes? *

Does student have any disabilities or special needs? *

If yes, please explain

We are asking for data on any students ages 8-21 who plan to attend our program. This information helps ensure our continued funding from the Bergen County Youth Services Commission to provide these camps for free. The information will be kept confidential. We very much appreciate your assistance in collecting this data.

If this doesn't apply to you, please indicate below:

No, This doesn't apply to me
Yes, This applies to me or my youth

Is the youth of Hispanic, Latino, or of Spanish origin?

How would you describe the youth?

American Indian or Alaska Native
African American
White
Asian
Native Hawaiian or Other Pacific Islander
Other

Who referred the youth?

School
Friend
Counselor
Parent/Relative
Crisis Intervention
Self
Therapist
Other

What type of school program does the youth attend?

Public
Private/Parochial
Alternative School
In-District Special Ed
Out of District Special Ed
In-Home Instruction
GED Prog/Adult Ed
Vocational
Not enrolled in any program
Other

Does the youth have any classifications in school?

Editorially Impaired
Cognitively Impaired
Emotionally Disturbed
Multiply Disabled
Traumatic Brain Injury
Specific Learning Disability
Autism
Communication Impaired
Visually Impaired
Orthopedically Impaired
Other Health Impaired
Social Maladjustment
Pre-School Disabled
None
Other

Family Household

Single Parent/Guardian
Dual Parent/Guardian
Other

What are the youth's current living arrangements?

At home with parent/guardian
Relative's home
Residential Placement Family
Friends
Foster Home
Homeless
Shelter
Other

Who is the youth's Primary Caregiver?

Biological Parents
Grandparents
Adoptive Parents
Other Relatives
Parent/Step-Parent
Other Non-Relatives

What is the Annual Income of the Household?

Selected Value: 50000

What is your primary source of income?

Employment
Unemployment/Temporary Disability
Public Assistance/Welfare
SSI/SSDI
Other

Does the youth have any problem areas?

N/A
Poor Problem Solving Skills
Alcohol or Drug abuse
Poor School Performance
Antisocial/Procriminal Attitudes
Lack of Remorse/Acceptance of Responsibility
Post-Traumatic Stress
Runaway Behavior
Low Self Esteem
Short Attention Span
Defies Authority
Sexually Acting Out
Medical problems/Juvenile
Disruptive Behavior
Suicidal Ideation/Gestures
No/Few Positive Friends
Verbally Aggressive
Physically Aggressive
Poor Anger Management
Poor Frustration Tolerance
Illiteracy
Poor Interpersonal Skills
Teen Pregnancy
Lack of healthy hobbies or interests
Other

I understand I am responsible for full payment and that tuition is non-refundable. I will not hold the Center for Modern Dance Education liable for any injuries incurred while participating in a class.

Signature

Emergency Policy*: For all medical emergencies, CMDE will attempt to contact a parent or guardian. In the event of serious medical emergency, 911 will be called. Students will be transported to Hackensack University Medical Center at 30 Prospect Avenue, Hackensack, NJ 201-996-3000

*In-person classes

Once you’ve registered for classes, please pay for the classes you will be attending.

All classes as of now are pay per class.

Single Class Price

Register Today

Choose the classes you want to register for:

I understand I am responsible for full payment and that tuition is non-refundable. I will not hold the Center for Modern Dance Education liable for any injuries incurred while participating in a class.

Emergency Policy*: For all medical emergencies, CMDE will attempt to contact a parent or guardian. In the event of serious medical emergency, 911 will be called. Students will be transported to Hackensack University Medical Center at 30 Prospect Avenue, Hackensack, NJ 201-996-3000