Mary Alice's Dance Studio
3815 N. Buffalo RD
Orchard Park NY 14127
716 662-1080
Fall 2011 Registration Form
Family Information
Parent's First Name
Last Name
Home Phone Number
Work Phone Number
E-mail Address
Cell Phone Number
Address:
City:
State:
Zip Code:
Emergency Contact
(Name and Phone #)
:
Student #1 Name:
Age:
Birthday :
Any Health or Physical Issues:
List all previous experience
Classes Interested In:
Mini Movers
Ballet
Tap
Jazz
Hip Hop
Musical Theater
Lyrical
Jazz Technique
Tap Technique
Student #2 Name:
Age:
Birthday:
Any Health or Physical Issues:
Classes Interested In:
Mini Movers (Combo)
Ballet
Tap
Jazz
Hip Hop
Musical Theater
Lyrical
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