PHAD Dance Class Enrolment
Please fill out the form carefully for registration
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
County
Postal Code
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Student Name
*
First Name
Middle Name
Last Name
Gender
Male
Female
N/A
Date of Birth
-
Day
-
Month
Year
Date
Child's current age
Does your child have any medical conditions?
Please select which classes you would like to enrol in:
*
PHAD Kidz Classic
Ballet
Tap
Modern
Contemporary
Musical Theatre
Jazz Technique
Acrobatic Arts
Did a friend refer you to PHAD? If so please tell us who so they can receive a reward in our referral scheme.
Please give any additional information
Register Class
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