EmailMe Form - Group Class/Satellite Enrollment Application

Today's Date *

MM / DD / YYYY

Class Semester *

Fall

Spring

Summer

What type of dance session are you interested in? *

Point of Contact Name *

Contact Email Address *

School/Organization Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

# of possible total students for class *

#of girls for class *

# of boys for class *

How did you hear about Ballet On Wheels Dance School? *

What Class Style / Dance Genre Are You Interested In? *

Where will classes be held at your facility? *

Student Class Dress Code *

Formal (leotard, tights, dance shoes )

Casual

# Of desired classes per week: *

Day(s) of the week classes will be held: *

Payment Option: *

School pay

Private pay (Parents)

Anticipated Start Date of Classes *

MM / DD / YYYY

Anticipated Completion Date *

MM / DD / YYYY

E - Signature