Debbie Strang Dance Center
Registration Form – Fall 2009
- 2010
Please Print
Student
Name ______________________________________________________
DOB ___________________Parent Name _________________________________
Address
_________________________________________________________
City: ________________________State __________Zip____________________
Home
Tel _________________________Work Tel _________________________
Class __________________________ Approval ______
Office Use Only
Class __________________________Approval _______ Date
__________Ck # _______
Class __________________________Approval _______
Amt. Paid $______________
I acknowledge
that dance is a physical activity and the Debbie Strang Dance Center and its faculty
and staff cannot be held responsible for injury or loss of or damage to personal property.
Parent
agrees to disclose any medical condition that may limit physical activity.
Parent
Signature _____________________________________Date ____________________
Please
tell us about your previous dance history, studio name, training, etc.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Debbie
Strang Dance Center
258 Salem Road, Plaza 129
Billerica, MA 01821
(978) 667-3452
New Mailing Address:
279 Andover
Road, Billerica, MA 01821
www.debbiestrang.com