Registration Form |
REGISTRATION FORM - FALL 2019/20 DATE:___________________________________ NAME:______________________________________________________________ ADDRESS:___________________________________________________________ EMAIL:_____________________________________________________________ CONTACT PHONE NUMBER:______________________________________________ DATE OF BIRTH:_______________________________ AGE:________________ PARENT(S) TO CONTACT:____________________________________________________________ TEEN EMAIL:_________________________________________________________ MEDICAL CONCERNS/ALLERGIES:_________________________________________ ____________________________________________________________________ PLEASE REGISTER FOR THE FOLLOWING CLASS(ES) CLASS/DAY/TIME COST _____________________________________________________________$ _____________________________________________________________$ _____________________________________________________________$ SUB TOTAL $ REGISTRATION FEE: $16.00 INDIVIDUAL $28.00 FAMILY TOTAL $ FORM OF PAYMENT: CHECK VISA/MASTERCARD VISA/MASTERCARD NUMBER:_________________________________________________________ EXP. DATE:_________________
PLEASE REMIT WITH PAYMENT IN FULL TO: DANCE UNLIMITED, 1415 HANOVER STREET, HANOVER, MA 02339, CALL STUDIO (781) 871-4264 OR EMAIL This e-mail address is being protected from spambots. You need JavaScript enabled to view it USE BACK SIDE IF NECCESSARY
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