Dance School, Lessons, Ballet - Charlestown, Rhode Island

tHE jENNIFER pRETE sCHOOL OF dANCE

2008/2009 Registration
$20 registration fee (individual) $30 registration fee (family)
Non refundable

STUDENT’S NAME: _____________________________________________________
STUDENT’S AGE: _____________________________________________________
DATE OF BIRTH: _______________________________

CLASS CHOICES (Please circle):

Ballet
Tap
Jazz
Hip Hop
Lyrical

CONTEMPORAry

modern

Pointe

NAME OF PARENT/GUARDIAN: ________________________________________

MAILING ADDRESS:___________________________________________________

HOME PHONE:       _____________________________________________________

CELL PHONE:         _____________________________________________________

EMAIL:                  _____________________________________________________

MEDICAL CONDITIONS/ALLERGIES OF STUDENT:_________________________

INSURANCE CARRIER AND POLICY NO.:________________________________

DANCE EXPERIENCE: (if so, where and how many years):

Please send completed registration form to:

email: jennifer@jpsdri.com

address: 1 Charlestown Beach Road, Charlestown, RI 02813

fax: (401) 633-7168