| TRICIA'S DANCE EXTREME |
| Registration |
| Tricia's Dance Extreme 211 South St Lehighton Pa,18235 610-377-5500 |
Student Name:___________________________________________
Address:________________________________________________
City_______________ State ____ Zip_____________
Age ____________
Birthdate:____________
School:____________________________________________________________
Grade:____
Number of years training:_____________
List 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:________________________________________________
Classes:Tap, Jazz, Hip-Hop, Modern, Ballet, Lyrical, Special Need classes( call
for details)
Class Name:___________________________
Private,Semi-Private,Group: ________________
1/2 Hr or Hour_________________
Competition Group:___________________
Competition Group is for everyone!!!!!!!!!
Please email form totricia@triciasdanceextreme.com
or mail to 211 South St Lehighton, Pa 18235
Address:________________________________________________
City_______________ State ____ Zip_____________
Age ____________
Birthdate:____________
School:____________________________________________________________
Grade:____
Number of years training:_____________
List 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:________________________________________________
Classes:Tap, Jazz, Hip-Hop, Modern, Ballet, Lyrical, Special Need classes( call
for details)
Class Name:___________________________
Private,Semi-Private,Group: ________________
1/2 Hr or Hour_________________
Competition Group:___________________
Competition Group is for everyone!!!!!!!!!
Please email form totricia@triciasdanceextreme.com
or mail to 211 South St Lehighton, Pa 18235
|
| Monthly Tuition Rates |
| Yearly Registration Fee $20 |
Tuition is based on a yearly
rate and is broken down in
to monthly payments.
rate and is broken down in
to monthly payments.
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