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Beverly's Dance Registration of Interest
Please fill out the following form if you are interested in dancing with Beverly's, and a representitive will be in touch with you shortly.
Student's First Name
*
Student's Last Name
*
Parent/Guardian's Name
*
Student's Age
*
Address
*
City
*
State
*
Postal Code
*
Phone
*
Secondary Phone
*
Email Address
*
Re-enter Email Address
*
Best Time to Contact
*
Morning
Afternoon
Evening
Does your child have any previous dance experience?
*
Yes
No
If yes, how many years and where?
Where did you find out about Beverly's Dance?
*
Email advertisement
Flyer or posting
Friend or family
Newspaper advertisement
Personal inquiry
Website advertisement
Other
Other
What location are you interested in?
*
Clay
Leeds
Argo
What type(s) of dance is your child interested in? (Check all that applies)
*
Jazz
Tap
Ballet
Clogging
Hip Hop
Musical Theater
Vocal
Contemporary Jazz
Pointe
Competition Team
Tumbling
Baton (Leeds Location)
Comments/Additional Information
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