TRICIA'S DANCE EXTREME
Tricia’s Dance Extreme
211 South St
Lehighton Pa, 18235
610-377-5500
Extreme Summer Program
Students Name _____________________________________________
Address ___________________________________________________
City____________ State____ Zip____________
Age ___________
Birthdate:____________
School:_______________
Grade:________
Number of years training:________
Any medical conditions we should be aware of :___________________
__________________________________________________________
Emergency Contact:___________________ Phone:_________________
Parent/Mother:_________________________
Home Phone:___-____-_____ Cell Phone ___-____-_____
Work Phone:___-____-____
Parent/Father:__________________________
Home Phone ___-____-____ Cell Phone ___-____-_____
Work Phone___-____-_____
Tuesday
____ 9:30am-11:00am Students 9 years old and up
~*~Tuition $55
____ 11:00am-12:00pm Students 4 years old – 8 Years old
~*~Tuition $40
Wednesday
____4:00pm-5:00pm Students 4 years old --8 Years old
~*~Tuition $40
____ 5:00pm-6:30pm Students 9 Years old and up
~*~Tuition $55
Extreme Summer Program will consist of a little bit of everything. Including
Hip-hop, Jazz, Lyrical, Modern, Ballet. This will give the students the chance to
explore the different areas of dance.
211 South St
Lehighton Pa, 18235
610-377-5500
Extreme Summer Program
Students Name _____________________________________________
Address ___________________________________________________
City____________ State____ Zip____________
Age ___________
Birthdate:____________
School:_______________
Grade:________
Number of years training:________
Any medical conditions we should be aware of :___________________
__________________________________________________________
Emergency Contact:___________________ Phone:_________________
Parent/Mother:_________________________
Home Phone:___-____-_____ Cell Phone ___-____-_____
Work Phone:___-____-____
Parent/Father:__________________________
Home Phone ___-____-____ Cell Phone ___-____-_____
Work Phone___-____-_____
Tuesday
____ 9:30am-11:00am Students 9 years old and up
~*~Tuition $55
____ 11:00am-12:00pm Students 4 years old – 8 Years old
~*~Tuition $40
Wednesday
____4:00pm-5:00pm Students 4 years old --8 Years old
~*~Tuition $40
____ 5:00pm-6:30pm Students 9 Years old and up
~*~Tuition $55
Extreme Summer Program will consist of a little bit of everything. Including
Hip-hop, Jazz, Lyrical, Modern, Ballet. This will give the students the chance to
explore the different areas of dance.
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