The Dance Experience - Registration

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

SUMMER 2010 REGISTRATION FORM

Dancer # 1 :		Date of Birth :
Class & Time or Camp Week:
Additional Classes :
# of Years with The Dance Experience :

Dancer # 2 :		Date of Birth :
Class & Time or Camp Week:
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.

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