Workshops Registration

Child Information

Child's Name

Gender Male Female
Parent/Gaurdian's Name
Address
,   
Email

Date of Birth

 Month/Day/Year Age as of September 2011
Years of Training Ballet Jazz Tap  
Phone Home
 Cell
 Work Other
Ages Workshop Length Dates - Mark to Register Time Cost

6-8

Ballet/Jazz

4 weeks

Sun, March 4-25, 2012

3:00-4:30PM

$140

Intro to Hip Hop

4 weeks

Sun, April 22- May 13, 2012

2:00-3:30PM

$140

9-12

Acting in Dance

4 weeks

Sun, Mar 4-25, 2012

3:00-4:30 pm

$140

Intro to Hip Hop

4 weeks

Sun, April 22- May 13, 2012

3:30-5:00PM

$140

 

Credit Card No:
Credit
Card:
Expiration
Date: 		Month:
Year:

Comments:

Emergency Contact Information

Name

Phone

Relationship

Please list any allergies, chronic illness or other medical conditions which teachers and medical personnel should be aware of:
Child's Primary Physician
 Phone

Program:
Please call 212-582-9304 ext 25 or 26 to be placed on the waiting list for any class marked FULL. No refunds up to 2 weeks prior to start date of each workshop. If a refund is issued, a $25 admin fee will be withheld

To register please conact Allie at ctp@bwydance.com or call 212-582-9304 ext. 25/26.