Registration for 2005-2006 School Year

Fall session starts Tuesday, September 6, 2005. No class Thursday, November 24, for Thanksgiving. Christmas Break - December 19, 2004, through January 1, 2005. Class resumes January 2, 2006.

Please print out this form and mail.  Call school director Gigi Murphy at 610-274-0420 to establish the appropriate level for your child.  Please note, students in Levels 1-4 are required to take all the technique classes offered at their level.

1. Name:______________________________________________

   Age: _______ Date of Birth: _____________________ mm/dd/yy

2. Name:______________________________________________

   Age: _______ Date of Birth: _____________________ mm/dd/yy

Previous Dance Training:

Class Attending:

__ Pre-Ballet
__ Ballet 1
__ Ballet 2
__ Ballet 3
__ Ballet 4
__ African Dance
__ Intermediate Pointe
__ Pantomime/Story Ballets
__ Jazz
__ Yoga

Address: __________________________________________________

City: _____________________________________________________

State: ____ Zip: ____________________

Phone: ___________________________________________________

Email: ____________________________________________________

Emergency Contact: ________________________________________

Address: __________________________________________________

Phone: ____________________________________________________

Cell/Phone: ________________________________________________