Questions? Email admin@sparkplugdance.org or call (541) 689-3233 and leave a message.

Your Information:

Please complete the information below and click "submit" to enter your class request(s).

Gift certificates

Is this a gift registration? If so, please enter the name and mailing address of the gift certificate recipient in the box below. Then enter your name, email address and/or phone number in the following section, and go directly to "submit form" at the bottom of the page.

• Gift certificate recipient:
  

Information about you and your child(ren)

• Your e-mail address
  
• Your name
  
• Child's name ("child 1")
  
• Child's age
  
• Sibling's name ("child 2")
  
• Sibling's age
  
• Your street address
  
• city, state and zip code
  
• phone number
  
• Please describe any special health or developmental issues that your teacher should know about:
  

Children ages 3 and over require additional information:

• Emergency contact person
  
• Relationship to child(ren)
  
• Contact's phone no.
  
• Known allergies for child one
  
• Known allergies for child two
  
• Child 1's physician
  
• Child 2's physician (if different)
  

Comments/Special Instructions

Have a question? Want to make a comment about the site or a class? Let us know and we'll get back to you!

• Comment/Question:
  

Payment information:


IF YOU CANNOT ATTEND CLASS PLEASE email admin@sparkplugdance.org or call (541) 689-3233 to CANCEL YOUR REGISTRATION so another child can fill your slot!!!

I will make an online payment through the page that appears after I click "submit form", below (I don't have to have a PayPal account to do this).

I will pay by mailing a check to Sparkplug Dance, PO Box 10955, Eugene, OR 97440

I am applying for a scholarship (download application form below). I am enclosing the $60 reduced registration fee with my application.

Scholarships are awarded based on financial need. A limited number of scholarships are granted each term on a first-come, first-served basis.  All scholarship applications MUST be received prior to the start of the term. You must re-apply for each term in which you wish to be considered for a scholarship.

To request a scholarship, please fill out and mail in a scholarship application form. Click to download a scholarship application form, or call (541) 689-3233 to request a form be sent to you by mail.