Dance Connection Rochester

2020-2021 Fall Registration

Student's Name:*

Student's D.O.B:*

Age:

Parent/Guardian's Name:*

Email Address:*

Street Address:*

City:*

Zip Code:*

Home Phone:*

Previous Dance Experience:

How did you hear about us:*

First Class:*

Second Class:

Third Class:

Fourth Class:

Please note: First installment is required to hold placement in the class!

Please add $25 Registration Fee if registering after July 4th!

Amount($):*

Card Holder Name:*

Card Number:*

Card Type:*

Card Expiration:

-

CVV Number:*

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