Registration
Form
215.245.6646
www.bcdancecenter.com
Date: ________________________
Name: ___________________________ Age: ________
DOB______________________
Address: _________________________________________________________________
City: _________________________State: _____________ Zip:
_____________________
Home Phone: _________________________
E-mail Address:
________________________________________________
Would you like BCDC to contact you with news and updates? Yes__________ No__________
Parents Names:
________________________________________________
Work Phone:
__________________________________________________
I would like to be enrolled in:
Beginner____ Intermediate_____ Advanced_____ Not sure_______
____ Kid’s Music Round (birth – 4 years)
____ Creative Dance (3-4)
____ Creative Too! (5-6)
____ Ballet/tap combo
|
____Ballet |
____Hip Hop |
____Program B |
|
____Pointe |
____Senior citizen soft shoe |
____Program C |
|
____Lyrical |
____Acrobatics |
____Salsa |
|
____Tap |
____Company |
____Adult Beginner Jazz |
|
____Jazz |
____Program A |
____Adult Open Classes |
|
____ Theatre Dance |
____ Modern |
|
Where did you hear about us?
Friend/word of mouth___ Sign____ Ad_____ Publication____
Other_____
Please list below previous dance education and experience
(NEW STUDENTS)
STUDIO
LENGTH OF STUDY
_______________________________ __________________________
_______________________________ __________________________
_______________________________ __________________________
Is there a class not listed in which you are interested?
_________________________________
I
have read and comply with the policies of the BCDC. Parent's
Signature____________________________________