The Dance Experience - Registration

The Dance Experience
159 Delaware Avenue
Delmar , NY 12054
(518) 463-1195
janellsdance@aol.com

2011 - 2012 REGISTRATION FORM

PLEASE COMPLETE ALL SECTIONS

Dancer # 1 :		Date of Birth & Grade:
Class Day & Time :
Additional Classes :
# of Years with The Dance Experience :

Dancer # 2 :		Date of Birth and Grade:
Class Day & Time :
Additional Classes :
# of Years with The Dance Experience :

Parent(s) Name(s):

Daytime Phone :

Evening Phone:

Cell Phone:

** Email Address:

Street Address :

City/Town:

State:

Zip Code:

EMERGENCY CONTACT (other than parent) ***parents will be attempted first***

Name:

Relationship:

Phone:

Please list any special considerations that we should be aware of:

** Our newsletters will be sent via email. Please include an email address.

YOU WILL NOT RECEIVE CONFIMATION UNLESS THE CLASS IS FULL .

THE DANCE EXPERIENCE
159 Delaware Ave
Delmar, NY 12054
(518) 463-1195