EmailMeForm
The Academy Registration Application
Fall 2016 Session: 10 Week(s)
Name (First, Middle, Last)
Age
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
Email
Classes Offered:
Get Right 4 The Night (Wednesday at 7 PM)
Beginners Acting and Audition Technique
Baby Ballet (2 -5)
Beginning Ballet
Beginning Tap
Intermediate Tap
Jazz Technic
Modern Improvisation
Piano
Voice (Private Only)
All beginning Instruments (Private Only)
Guardian's Name
Guardian's Phone
Cell Phone
In Case Of Emergency, Call:
Phone
Cell Phone
Signature
*
Clear
Date
*
MM
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YYYY