2010/2011 Registration Form

(Fill out and submit)

(A REGISTRATION IS NOT COMPLETE WITHOUT $20.00 REGISTRATION FEE -

Please mail a check to 101 Union Avenue, Johnstown, NY  12095)

Dancer's Name

Parent's Name(s)

Address

E-mail Address

Home Phone

work phone

Emergency Contact

Relationship & Phone Number

Age (as of 9/1/10)

Birthdate

Grade

Previous Dance Training (place & length of time)

Allergies or Medical Conditions

How did you choose us?  (check all that apply)

Comments

CHECK SUBJECTS YOU WILL BE TAKING: (indicate how many of each)

*Pointe students must have teacher recommendation and be enrolled in at least 3 ballet classes per week

*Lyrical students must be enrolled in at least two ballet and one jazz class per week

Monthly Tuition is $45.00 for first class; $25.00 for second class; $15.00 for each additional class

MONTHLY TUITION - $

Monthly payments payable by Cash, Check or Credit Card

High Performance Dance Center

"Turning Dreams Into Reality"

Newspaper

Yellow Pages

Day Care

Website

Friend/Relative (list name in comment section

Other (explain in comment section)

TAP

JAZZ

CLASSICAL BALLET

PRIMARY TAP/JAZZ COMBO

POINTE*

LYRICAL*

KINDERDANCE (Ages 3-5)

HIP-HOP

Postcard