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Evergreen Dance Center Registration Form

Students must be 3 years old by Sept. 17, 2012
You may register online using the form below.
You will need to know the class name, time and day.
Longview schedule           Branch schedules
Please be sure to fill out the form completely.  Incomplete forms will not be processed.
Parent/Guardian Name:
Date:
Month
Day
Year
Address:
City:
State
Zip Code:
Home Phone:
Cell Phone:
Work Phone -- Mom:
Dad:
Emergency Contact:
Emergency Phone:
Branch Student will attend:
Student Information
Student 1 -- Name:
Date of Birth:
Month
Day
Year
Class 1:
Class 2:
Class 3:
Student 2 -- Name:
Click to see the class schedule for Longview or for the Branch studios.

Date of Birth:
Month
Day
Year
Class 1:
Class 2:
Class 3:
Total Hours of Classtime for all students:
Monthly Tuition Due:
Click here to see the complete fee schedule.
New Student?
Yes
No
If yes, how did you hear about Evergreen Dance Center?
Additional information we need to have, if any:
(If you need more than 3 classes for a student, or have more than two students, you may write additional classes and students here)
Would you like to recieve e-mail notices from Evergreen Dance Center?  If yes, please enter your e-mail address:
Please re-enter Email address: