2022-2023 New Bremen Dance Registration Form
Students Name: ______________________________________________________
Parents Name: ______________________________________________________
Address: ________________________________ City:______________________ Zip: ______
Email Address: ___________________________________ Phone Number: _____________________
Birth date _______________ Age (as of 7-31-2022): _________ Grade entering (as of fall 2022): ________
What class would student like to enroll in?
|____ Combination Dance class (age 6 and up)||____ Introduction to dance class (age 3 1/2 to 5)|
|____ Girls tumbling class (age 4 and up)||____ Ballet class (age 10 and up – prerequisite for Pointe class)|
|____ Pointe class|
• What previous experience has the student had in dance or gymnastics? (where, how long, etc.)
• How many years has student attended New Bremen Dance School? Tumbling ___ Dance ____
• Is your daughter earning a trophy this year? If yes, write in the year trophy she is earning. _____
• The student cannot take lessons on the following days or times: _________________________________
• If your child took lessons from New Bremen Dance School during the 2021/2022 season are there any comments (good or bad) you wish to let me know about ?
Registration Fee: $15.00 (Nonrefundable) _________Check _________Cash
Parents Signature ______________________________________________________
Please send this form to: firstname.lastname@example.org or mail it to Miss Lynda’s home address.
Send the $15.00 fee to: Lynda R. Davis | 232 S Washington Street | New Bremen, Ohio 45869-1251 | Please call or text me at 419-234-0630 to inform me that you’ve sent the form in to be processed!