THE DANCE GALLERY
781-602-0880
523 Franklin Street, 2nd Floor, Melrose, Ma.
email: dancegallerymelrose@yahoo.com
www.dancegallerymelrose.com
facebook.com/dancegallerymelrose 

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REGISTRATION FORM


Student Name:  _______________________________________ Date of Birth:  ___________________ Grade in Sept.: _____________ 

Address:  __________________________________________________________________________________
                               Street                                                    City                                         Zip 

Home phone #: ___________________________          Cell Phone:  _________________________

                 Email: ______________________________________________________________________ 

Parent's Name: __________________________________     Work #: (_____)________________________ 

Parent's Address: ______________________________ (If different from student) 

    In the event the class is cancelled, please contact me at Phone #:     (_____)______________________________
                                             
__________________________________________________________________________________________ 

PLEASE CHECK THE CLASSES YOU ARE INTERESTED IN:
        
    _______ TAP                                        _______ BABY DANCE (2 1/2 - 3 yrs)
    _______ JAZZ                                      _______ KINDERDANCE I (3 - 4 yrs)
    _______ LYRICAL                                _______ KINDERDANCE II (5 - 6 yrs)
    _______ CLASSICAL BALLET             _______ ADULT CLASSES
    _______ POINTE                                 _______ COMPETITION TRAINING
    _______ GYMNASTICS                       _______ SPECIALTY CLASSES
    _______ IRISH DANCE                       _______ OTHER_____________________________________________
    _______ HIP – HOP      

       

We also offer private and semi-private instruction. Are you interested ? YES _____ NO _____