Fall 2023 Registration Form                               Andrea's School of Dance
426 Main Street, Bellwood, PA 16617
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Email *
First Name *
Last Name *
Date of Birth *
Age *
Grade as of September 2023
Address *
City, State and Zip Code
Phone Number or Mobile Number *
Name of Parents/Guardians *
Emergency Contact
Emergency Contact Phone Number
Please list all allergies or other physical restrictions.  Include other pertinent information here.
Years of dance experience
Last year of dance instruction
Types of dance studied
Please choose the dance classes you would like to enroll in.  

Please note that students must be 5 years old to enroll in Jazz.

Lyrical and Modern classes require a minimum of two years of ballet experience and students must also be currently enrolled in and attending a ballet class.  

Hip-Hop students must be 10 by 12/31/2023 and currently enrolled in and attending a jazz class.
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A copy of your responses will be emailed to the address you provided.
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