POSITION ONE SCHOOL OF DANCE
REGISTRATION FORM
2010-2011

Ages  2 ½  - 4:    First Steps __________          Ages  5 - 6:     Ballet/Tap __________                                  

Ages  7 – Adult:     Ballet__________     Jazz__________     Tap__________                                              

Pointe:     Beginner__________     Advanced__________                                                                             

Hip Hop:     Ages  5 – 7__________     Ages  8 – 12__________     (Day TBD)                                           

*Options:     Monday – Friday____________     Saturday____________                                                  

PLEASE PRINT:
Student Name:___________________________________________ Age:______ Birthdate:______________

Address:__________________________________________________________________________________
                   Street                                                         town                                       state                          zip      

Home Phone:________________________________        Cell Phone:________________________________

Physical Limitations:_______________________________________________________________________

Mother’s Name:__________________________________________    Work Phone:  ___________________

Father’s Name:__________________________________________      Work Phone: ___________________

Web Site:  ______________________________________________________________

Military Personnel:    Yes ______   No ______   Expected Transfer Date:____________________________
May we use your child's photo(s) for advertising (brochure, web, etc.) purposes?          YES          NO 

NEW STUDENT HISTORY:                                                                                                                                
     Have you taken dance lessons before?   Yes_____  No_____   Location/School______________________

Ballet______yrs.     Jazz______yrs.     Tap______yrs.     Other:_____________________________________

How did you hear about Position One?_________________________________________________________

OFFICE USE ONLY:                                             
                                                                                                                                                                                                         
 # Family Members:_______________                                            Total Monthly Tuition:_______________

                                                                                                                                    Discount:_______________

                                                                                                                                        Total: _______________
  Registration Fee:  _________________