Workshops Registration

Child Information

Child's Name

Gender Male Female
Parent/Gaurdian's Name
Address
,   
Email

Date of Birth

 Month/Day/Year Age as of September 2009
Years of Training Ballet Jazz Tap  
Phone Home
 Cell
 Work Other
Ages Workshop Length Dates - Mark to Register Time Cost
6-8 Intro to Hip-Hop 4 Weeks Sun, Oct 3-24, 2010 2:00-3:30 pm
$125
Intro to Hip-Hop 4 Weeks Sun, Jan 9-30. 2011 2:00-3:30 pm
$125
Intro to Hip-Hop 4 Weeks Sun, Mar 6-27, 2011 2:00-3:30 pm
$125
9-12 Intro to Hip-Hop 4 Weeks Sun, Oct 31-Nov 21, 2010 2:30-3:30 pm
$125
Ultimate Theater 2 Days Thu/Fri, Dec 9-10, 2010 5:00-7:00 pm
$80
Intro to Hip-Hop 4 Weeks Sun, Jan 9-30, 2011 3:30-5:00 pm
$125
Ultimate Theater 2 Days Thu/Fri, Jan 27-28, 2011 3:30-5:00 pm
$80
Intro to Jazz 4 Weeks Sun, Mar 6-27, 2011 4:30-6:00 pm
$125
11-17 Camera Ready 4 Weeks Sun, Oct 31-Nov 21, 2010 2:30-4:00 pm
$125
Clogging 2 Days Thu/Fri, Nov 18-19, 2010 4:30-6:00 pm
$80
13-17 Intro to Jazz 4 Weeks Sun, Oct 3-24, 2010 3:30-5:00 pm
$125
Ultimate Theater 2 Days Thu/Fri, Dec 16-17, 2010 5:00-7:00 pm
$80
Ultimate Theater 2 Days Thu/Fri, Feb 3-4, 2011 5:00-7:00 pm
$80
*Includes video of workshop
 

Credit Card No:
Credit
Card:
Expiration
Date: 		Month:
Year:

Comments:

Emergency Contact Information

Name

Phone

Relationship

Please list any allergies, chronic illness or other medical conditions which teachers and medical personnel should be aware of:
Child's Primary Physician
 Phone

Program:
Please call 212-582-9304 ext 25 or 26 to be placed on the waiting list for any class marked FULL. No refunds up to 2 weeks prior to start date of each workshop. If a refund is issued, a $25 admin fee will be withheld

To register please conact Emily or Allie at ctp@bwydance.com or call 212-582-9304 ext. 25/26.