REGISTRATION FORM

Student Name:

Address:

City:
State :
Zip:

Phone: Home:
Work:
Cell:

Email Address:

For Youth: Parents Name:

For Youth Birthday (MM/DD/YY):

For Adult: Birthday (MM/DD):

Emergency Contact Name:

Emergency Phone:

Classes - please verify day/time of classes below:
Tap
Argentine Tango
Art
Creative Movement
Hip Hop
Home School Fine Arts Program
Intro to Dance
Tai Chi
Vocal Chorus
Yoga
Zumba
Summer Playhouse


Private Lessons: Voice, Piano, Guitar, Tap & More.

(exact time to be scheduled/ instructor

Day/Time of Class(es)/Week for Summer Playhouse:

Special Needs of the student: