2020-2021 Student Registration Form
A one time registration fee of $20 per family is due for new students. Returning families who did not register prior to June 20, 2020, will be charged a $10.00 registration fee. Please send your check made out to the Blair Dance Center to: 8738 Raven Oaks Drive Omaha, NE 68152 We must have this registration fee to hold your child's place in class.
Please Choose One
New Student
Former Student
Student Name
First Name
Last Name
Student Birthdate
-
Month
-
Day
Year
Date
Grade in School
New Students: Please list any previous dance experience.
Parent/Guardian #1
First Name
Last Name
Email #1
example@example.com
Phone Number
Parent/Guardian #2
First Name
Last Name
Email #2
example@example.com
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate classes that you would like to add on to the required core technique class.
Pom (Grades 1-12)
Hip Hop (Grades 2-12)
Clogging (Grades 4-12)
Pointe (Grades 6-12 upon instructor's approval)
Liturgical Dance (Grades 4-8)
Please list any medical conditions or allergies
To help with scheduling, please list any conflicts . days/times
I can make a class time before 5:00.
Yes
N0
Other
Submit
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