Langley Dance Academy by hcj

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									LANGLEY
DANCE    ACADEMY




                        Registration Form (Please print clearly)
Student Name
Parent Name
Address
(include postal code)



Date of Birth
Phone Number
Work Number
Cell Phone
Email address
Credit card # &
expiration date

Dance Class                                    Day of Week                Time




                                       Please check one box
                                       I consent with having the above dance student appear on the
                                       Langley Dance Academy web page
    Privacy                            (www.langleydanceacademy.com) and/or in studio
                                       advertising.
  Information
                                        I DO NOT consent with having the above dance
                                       student(s) appear on the Langley Dance Academy web page
                                       or studio advertising.




 Signature:                                               Date:

								
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