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Ballet, Tap & All That Jazz-Registration Form
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* Indicates required question
Email
*
Your email
Student First Name
Your answer
Student Last Name
*
Your answer
Work/Business Phone
*
Your answer
Home/Mailing Address
*
Your answer
Birthdate
MM
/
DD
/
YYYY
Registation Type
*
Choose
Child
Adult
Home Phone
Your answer
Age of Child-2
Your answer
Parent Name: Last/First
*
Your answer
Emergency Contact Information-First Name, Last Name, Contact Phone
*
Your answer
Cell/Mobile Phone
*
Your answer
E-Mail Address
*
Your answer
Emergency Contact Relationship
*
Choose
Parent
Grandparent
Family Member
Family Friend
Option 5
Class Type/Program Type
*
Pre-Ballet/Creative Movement
Kinder Tap 5-6
Tap ages 7-12
Tap (Ages 13-Adult)
Modern Dance I
Modern Dance II
Afro Jazz
Teen/Adult Ballet -Tuesday
Beginning Ballet 12-17
Beginning Adult Tap
Youth Jazz
Beginning Ballet 7-9
Ballet technique
Pointe Audition Only
After- School Program
Required
Payment
*
http://www.paypal.me/BTATJ
Pay on site
Other:
Date of Registation
MM
/
DD
/
YYYY
Time
:
AM
PM
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