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2187 Wehrle Drive
Williamsville, New York 14221
(716) 626-4050

Fall Registration Form (Printable)

 

[Click link at bottom of this page to DOWNLOAD the form]


PLEASE RETURN COMPLETED REGISTRATION FORM TO
 


2187 Wehrle Drive

Williamsville, NY 14221

(716) 626-4050

www.dancentralstudios.com

(Please Print)

 

Student’s Name ____________________________________________________________

 

D.O.B. (if under 18 years) __________________________  Current Age __________________

 

Street Address _____________________________________________________________

 

City ______________________________  State __________  Zip Code _________________

 

Home Phone ____________________________  Cell Phone __________________________

 

Business/Emergency Phone _________________  Email Address _________________________

 

Name of parent or guardian (if under 18 years)  _______________________________________

 

 


Were you one of our students last year?  Yes ________  No ________

 

If yes, what was the day and time of your class/classes?  _________________________________

_______________________________________________________________________

 

If no, do you have previous dance experience? ________________________________________

 

Circle type of dance desired:  Tap, Jazz, Ballet, Acrobatics, Hip-Hop, Gymnastic Team, Other:  _________

_______________________________________________________________________

 

Prefer:  Weekday Classes ________  Saturday Classes ________

(Gymnasts will be scheduled in conjunction with workout times.)

 

Do you have any physical limitations? ______________________________________________

_______________________________________________________________________

 

How did you hear of us? _______________________________________________________

 

Remarks:  ________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________


 

 

I, the undersigned will not hold Dancentral/Joyce Miller Lichtenberger responsible for the loss of, or damage to personal property or any injury sustained therein.

Signature X ___________________________________  Date ______________________ Parent or Guardian (if under 18 years)

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