The Dance Department in Clifton Park, NY

Please fill out the following form to register for a class. Payment due at first class.

Parent's Name

Phone-day

Phone-eve

E-mail

Address (no PO box)

City

State

Zip

Student's Name

Student's age

Student's Date of Birth

Choose a class to register for below. Be sure to check the Schedule page for more info about classes and times.

Does student have any illness, allergies, health problems or learning concerns we should know about?
No Yes If Yes, please list:

Does student have previous dance training? No Yes If Yes:

Where?		When?
How long?		What style?

Emergency contact Information

Name

Phone number

Please send me your upcoming class schedules.

Please add me to your mailing list.

Question or comments:

.Payment due at first class.