Fall Schedule

Celebrating 37 Years!

| 215.368.8785 | Fax: 215.794.0758 | Marlyn Abramson, Director | Trina Homing, Studio Assistant Director |

Lansdale Studio Fall 2010 - 2011

ALL LEVEL II AND ABOVE MUST HAVE PRIOR DANCE EXPERIENCE

Registration Form

New Dance Workshop - Lansdale

Class size is limited - One student per form. Please print and return the form below with a $25.00 non-refundable registration and processing fee for each student.

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

______________________________________________________________________________________________

Parent'S Name: _________________________________________________________________________________

Phone#: ____________________ Work#: ________________________ Cell#:______________________________

Age as of Sept. 2010: _____________________ Date of birth:___/______/______

Allergies/Medical Conditions: _______________________________________________________________________

______________________________________________________________________________________________

Name of school attending fall 2010: __________________________________________________________________

Grade Sept. 2010: _______________________________________________________________________________

Years dance experience: __________________________________________________________________________

How did you hear about us? _______________________________________________________________________

For all combination classes, please select TWO choices.

Class selection: _________________________________________________________________________________

Day: ________________________________________ Time: _____________________________________________

Class selection: _________________________________________________________________________________

Day: ________________________________________ Time: _____________________________________________

Class selection: _________________________________________________________________________________

Day: ________________________________________ Time: _____________________________________________

Class selection: _________________________________________________________________________________

Day: ________________________________________ Time: _____________________________________________

$_____________Total Tuition Due Sept. 1, 2010.

$25.00................ Non-refundable deposit.

$____________ Balance Due.

Liability Release. I release New Dance Workshop from all liability, from injury, damage or loss of property.

_________________________________________________________________________________________________
Parent's Signature (REQUIRED).

Please make checks payable to: Marlyn Abramson's New Dance Workshop
Return to: P O BOX 221, Lahaska, PA 18931

Emergency Contact:_________________________________________________________________________________

Email:____________________________________________________________________________________________