Summer Registration 2019
To register for summer classes, please complete the form below and click the submit button at the bottom. For the ENTIRE summer schedule of classes, click "CLASSES" (above, top left) and then click on "Summer Schedule".
Date of Birth: * Age as of July 1st: * Reponsible Parent or Guardian: *
Street Address: *
Town/City: * Zip: *
Home Phone (with area code):
Parent(s) Cell Phone Number: *
Parent(s) Work Phone Number:
Parent(s) Email address: *
In case of Emergency
Name: Phone: Relation:
Student's Cell Phone Number (if available):
Student's Email Address (if available):
Classes will be added or dropped due to demand.If you have any questions, please call us at 617-471-5678.
Classes requested: (list subject and DAY and TIME of Class)Class 1: *
The Studio will contact you for your credit/debit card information.
Years of Previous TrainingBallet: Tap: Jazz: Streetdance: Pointe: Other:
How did you hear about Lisa's Dance Studio? *
Does your child have any medical problems or is she/he limited in any way? *
Do we have permission to use your child's photograph or video for advertising purposes? Yes No *(must select Yes or No)
Full name of person completing form: * Date: *
* = Required items
Lisa's Dance Studio | 101 Adams St, Quincy, MA 02169 | (617) 471-5678 | DanceStudioMail@aol.com
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