2020-2021 Registration Form

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
Should be Empty:

2020-2021 Student Registration Form