Registration Form
2010 - 2011 Dance Season
New Student
Current Student
Parent's Name
Address
City State Zip Code
Phone Number (Home)
(Work)
1. Student's Name
Years of Dance Experience
Birthday Age
Registering for the following class(es):
Day
Form of Dance
Time
Day
Form of Dance
Time
Day
Time Form of Dance
Day
Time
Form of Dance
2. Student's Name
Age
Years of Dance Experience
Birthday
Registering for the following class(es):
Form of Dance
Day
Time
Day
Time Form of Dance
Day Form of Dance
Time
Form of Dance
Day
Time
3. Student's Name
Years of Dance Experience
Birthday Age
Registering for the following class(es):
Day Form of Dance
Time
Day
Time
Form of Dance
Day
Time Form of Dance
Time
Day Form of Dance
E-Mail Address
Do you have any questions or comments?
There is a $10.00 registration fee per family.

Please send your $10.00 fee to:   The Dance Company
                                                     Tina Harding
                                                      20 North View Park
                                                      Attica, NY 14011

You will be registered for the class once the payment has been received.  The class size will be limited, so please do not delay!

                                Classes begin September 13th!