DANCE CENTRAL
performing arts, LLC
46 East Central Avenue
Pearl River, New York 10965 Telephone #: 845 627-0595
www.dancecentralperformingarts.com
dancecentralperformingarts@hotmail.com
REGISTRATION FORM
STUDENT'S NAME: ________________________________________________
STUDENT'S AGE: ________________________________________________
ADDRESS: __________________________________________________
_________________________________________________
HOME TELEPHONE: _________________________________________________
STUDENT'S CELL PHONE: _____________________________________________
STUDENT'S E-MAIL: __________________________________________________
PARENT'S CELL PHONE: ______________________________________________
PARENT'S E-MAIL: ____________________________________________
EMERGENCY CONTACT: _______________________________________________
I HAVE READ, AND ACCEPT THE RULES AND REGULATIONS OF DANCE CENTRAL PERFORMINTG ARTS.
Signed: ________________________________ Dated: ______________________
I GIVE PERMISSION TO USE MY CHILD’S PICTURE ON THE DANCE CENTRAL WEBSITE (NO NAMES WILL EVER BE USED)
Signed: ________________________________ Dated: ______________________
