Greensboro Dance Theatre ~ Registration Form 2005-2006

2604 Battleground Ave.    Greensboro, NC    27408

Dancers Name_______________________________________________ Age_____________

Please complete this form and return to the studio with your $20.00 non-refundable registration fee and your tuition.  This will reserve your child a place in our program.  If you choose not to study this fall, please notify the studio so we may allow another child the opportunity.

Please check one: Returning Student  ______________ Beginning Student  _________________

Please indicate your referral about our program:

____Newspaper Ad     ____Radio/Television Ad      ____Friend      ____Flyer     ____Relative      ____Yellow Page Ad

Parents Last/First Name ________________________________________________________

Address ____________________________________City___________________________

State________ Zip Code _________ Home telephone number (_____)__________________________

Student’s Last Name______________________ First__________________________________

School attending _____________________ Grade __________ Birthday_____________________

Years in dance __________List previous dance teacher(s) ____________________________________

Family doctor ______________ Office phone number__________ Medical information we should know_________

 In case of emergency__________________________ Phone number_________________________

Mother’s name______________________________ Employer __________________________

Mother’s business phone number __________________ Mother’s cell phone number ____________________

Father’s Name ______________________________ Employer __________________________

Father’s business phone number ___________________ Father’s cell phone number____________________

Email Address for Reminders and Notices ________________________________________________

Classes desired:

Ballet _________ Pre Pointe __________ Pointe ________ Jazz _______ Lyrical ________ Modern  ________     

Tap  _________  Hip-Hop _______ Competition _______ Adult Classes _________

I would like for my child to dance: 1 day a week ____ 2 days a week ____ 3 days a week _____

I  __________________________________ understand and agree with the studio polices in the brochure.  I also understand that a $10.00 late fee will be charged to my account after the TENTH of the month on any unpaid balance. 

Parent signature______________________________________________ Date____________