REGISTRATION FORM

SUMMER 2011

NAME:___________________________AGE:_____DOB:__________

ADDRESS:________________________________________________

CITY:____________ZIP:________PHONE:______________________

E-Mail:____________________________

AMOUNT ENCLOSED: $___________

FULL WORKSHOP-2 WEEKS July 25-29/August 8-12th: Please circle one

Intensive Level One, ages 7-10: $450.00

Intensive Level Two, ages 10-13: $450.00

Intensive Level Three, ages 13 & Up: $450.00

ONE WEEK ONLY-Please circle week one or week two

Level One, ages 7-9: $275.00 Level Two, ages 9-12: $275.00 Level Three, ages 13 & Up: $275.00

Week 1 Week 2 Week 1 Week 2 Week 1 Week 2

To reserve your place in class, please print this form, circle the desired program, and submit completed registration form and fees to The Dancer’s Studio no later than July 20th, 2011. Single class rate is $15.00 per hour. Tuition is not refundable. Please note: students wishing to be considered for the Legacy Dance Team 2012 must be registered for the full two week workshop.

The Dancer’s Studio

855 Forest Road—PO Box 536

Northford, CT 06472