The Dance Experience
159 Delaware Avenue

Delmar , NY 12054
(518) 463-1195
janellsdance@aol.com

2010 - 2011 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.


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

info@thedanceexperienceofdelmar.com