Attitudes
Center for the
Performing and Visual Arts
Registration 2010
Date: ____________________________
LAST NAME:
_____________________________________________________FIRST
NAME:____________________________________________________________
PARENTS’
NAMES:
_________________________________________________________________________________________________________________________
ADDRESS:___________________________________________________________________________________________________________________________________
CITY:_________________________________________________________STATE:_________________________________________
ZIP:_________________________
HOME PHONE:
_______________________________________________STUDENT’S CELL PHONE:
_________________________________________________
FATHER’S
WORK/CELL PHONE: _________________________________ MOTHER’S WORK/CELL PHONE:
__________________________________
IN CASE OF
EMERGENCY/SNOW CANCELLATION CALL:
_______________________________________________________________________________
PARENT’S
E-MAIL ADDRESS:
_____________________________________________________________________________________________________________
STUDENT’S
E-MAIL ADDRESS (IF DIFFERENT):
________________________________________________________________________________________
AGE:
________ D. O. B.__________________
SCHOOL ATTENDING: _______________________________________________________ GRADE:
_________
MEDICAL
LIMITATIONS/ALLERGIES:
____________________________________________________________________________________________________
PREVIOUS
DANCE
TRAINING:_____________________________________________________________________________________________________________
YEARS ON
POINTE:_________________________________________________________________________________________________________________________
CLASSES YOU
WILL BE TAKING:
_________________________________________________________________________________________________________
MONTHLY
TUITION: _____________________________________________________METHOD OF PAYMENT:
______________________________________
DATE
PAYMENT WILL BE RECEIVED:
____________________________________________________________________________________________________