Registration of Interest Form

Student's First name

Student's Last name

Student's Birthday

Month

Day

Year

Students Age

Parent/Guardians First and Last Name

Address

Email*

Phone

Best Time to Contact

Does your child have any previous dance experience?*

Yes

No

If yes, how many years and where?

How did you hear about Beverly's Dance?

Email Advertisement

Flyer

Social Media

Newspaper Advertisement

Personal Inquiry

Website Advertisement

Other

What location are you interested in?*

Leeds

Argo

What type(s) of dance is your child interested in? (Check all that applies)*

Jazz

Tap

Ballet

Clogging

Hip Hop

Musical Theater

Vocal

Contemporary Jazz

Pointe

Competition Team

Tumbling

Baton (Leeds Location)

Comments/Additional Information

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