Registration Form

To enroll in classes, camps, or workshops, fill out the enrollment form below,
and send in your registration fee and first month's tuition and/or your camp/clinic payment to reserve your spot.

Name:
__________________ Age: ____DOB: _____
Home Phone:
____________________
Address:
_____________________________________
Work Phone:
____________________
Parent(s)/ Guardian:
_____________________________________
Cell or other:
____________________
E-mail address:
_____________________________________
 
Emergency Contact:
_____________________________________
Emergency #:
____________________
Doctor's Name:
_____________________________________
Doctor's #:
____________________
Years of Dance Training:
_____________________________________
Allergies:
____________________
 
Should we be aware of any conditions or circumstances that may effect student's training?
____________________________________________________________________________________
How did you hear about Center Stage? Newspaper, Flyer, Drove by, Friend, Web site, Other:
____________________________________________________________________________________
Please indicate the class(es) for which you would like to register:
____________________________________________________________________________________
For New Student Registration: (car decal is included in registration fee)
___I would like a car window decal with my child's name ________________________.
___I would like a decal without my child's name. (Center Stage logo only)
___I do not want a decal.


Mail To:
Center Stage
2405 S Highway 183 Suite 104
Leander, TX 78641



©2005 Brandt Enterprises