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