Student Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Parent/guardian #2

optional; include any other adult who may be involved with studio communication

First Name

Last Name

Phone

(###)

###

####

Student Date of Birth *

MM

DD

YYYY

Class selection

Choose all applicable.

Pre-Primary Ballet

Primary Ballet

Ballet (level determined on enrollment)

Broadway Jazz (level based on age)

Junior Company (age 7 - 10)

Senior Company (age 11 - 18)

Private Training

Modern & Contemporary

Acting ( 12 week session)

Photo sharing permission *

Allow Genesee Dance to use photos of your child taken during classes or performances in promotional materials which may include social media accounts, our website and printed brochures. We do not publish dancer names with photos.

Yes

No