Workshops Registration

Child Information

Child's Name

Gender Male Female
Parent/Gaurdian's Name
Address
,   
Email

Date of Birth

 Month/Day/Year Age as of September 2011
Years of Training Ballet Jazz Tap  
Phone Home
 Cell
 Work Other

Ages

Workshop

Length

Dates

Time

Cost

 
6-8 Intro to Hip Hop 2 Weekends Sat & Sun Aug 4-12 2012 1:30-3:00 pm $140
Beg Jazz/Ballet 4 weeks Sun Jan 6-27 2013 2:00-3:30 pm $140
Triple Threat 4 weeks Sun Mar 3-24 2013 2:00-3:30 pm $140
Intro to Hip-Hop 4 weeks Sun April 14-May 5 2013 2:00-3:30 pm $140
9-12 Intro to Hip Hop 2 Weekends Sat & Sun Aug 4-12 2012 3:00-4:30 pm $140
Beg Jazz 4 weeks Sun Jan 6-27 2013 3:30-5:00 pm $140
Acting in Dance 4 weeks Sun Mar 3-24 2013 3:30-5:00 pm $140
Intro to Hip Hop 4 weeks Sun Apr 14-May 5 2013 3:30-5:00 pm $140

 


 Credit Card No:
Credit
Card:
 1 1
Expiration
Date: 		Month:
Year:

Comments:

Emergency Contact Information

Name

Phone

Relationship

Please list any allergies, chronic illness or other medical conditions which teachers and medical personnel should be aware of:
Child's Primary Physician
 Phone

Program:
Please call 212-582-9304 ext 25 or 26 to be placed on the waiting list for any class marked FULL. No refunds up to 2 weeks prior to start date of each workshop. If a refund is issued, a $25 admin fee will be withheld

To register please conact Allie at ctp@bwydance.com or call 212-582-9304 ext. 25/26.