DANCE EXPRESS REGISTRATION FORM

68 Hartford Turnpike
Tolland, CT 06084

Studio (860) 871-1922
Fax (860) 871-1571

Please complete your application on-line here,
or print the form and return with your payment to Dance Express.

	DANCE EXPRESS - REGISTRATION FORM PLEASE COMPLETE THE FOLLWING FORM AND CLICK 'SUBMIT' ONE REGISTRATION FORM PER CHILD PER CLASS   STUDENT’S NAME: BIRTHDATE YEARS OF DANCE COMPLETED CURRENT STUDENT: YES NO PARENT’S NAME: PHONE: (C): ADDRESS: TOWN: ZIP: Select Days: Monday Tuesday Wednesday Thursday Friday Saturday Enter Age/Level: Enter Class Time: Select Class Type: Ballet Jazz / Hip Hop Hip Hop Progressive Movement Jazz Tap Acro / Jazz Tap / Jazz Lyrical Tap / Progressive Mommy & Me T L J Comments/ Questions TOTAL: *PAYMENT DUE IN FULL AT REGISTRATION * AMT PAID:     $12 registration fee is per child, NOT per class.
	DANCE EXPRESS - 68 HARTFORD TURNPIKE - TOLLAND , CT 06084 - (860) 871-1922

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