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Student's Name:*

Student's D.O.B:*

Age:

Street Address:*

City:*

Zip Code:*

Home Phone:*

Previous Dance Experience:

Parent/Guardian's Name:*

Email Address:*

Phone Number(During Camp Time):

How did you hear about us:*

Camp/Class Requesting:*

Amount($):*

Card Holder Name:*

Card Number:*

Card Type:*

Card Expiration:

CVV Number:*

1385 Empire Blvd, Rochester,
NY 14609, United States

Monday - Thursday
3:00 pm - 9:30 pm

Friday
3:00 pm - 9:00 pm

Saturday
8:30 am - 2:00 pm

Sunday - Closed

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