BDC Fall 2011 / 2012

Family Information
Parents Names *
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Address *
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Address (cont)
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City *
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Invalid Input		 Zip *
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Home Phone *
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email *
please enter a valid email address
Referred by?
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Student Information
Student 1 Name *
Please enter at least 1 student name!		 Age *
Please enter the age for Student 1!		 DOB *
Please enter a date of birth for Student 1		 Years Dancing *
please enter the number of years Student 1 has danced
Student 2 Name
Please enter at least 1 student name!		 Age
enter the age as digits (ie 16)		 DOB
Years Dancing
please enter the number of years Student 2 has danced as digits (ie 16)
Student 3 Name
Age
enter the age as digits (ie 16)		 DOB
Years Dancing
please enter the number of years Student 3 has danced as digits (ie 16)
Student 4 Name
Age
enter the age as digits (ie 16)		 DOB
Years Dancing
please enter the number of years Student 4 has danced as digits (ie 16)

Classes Registering For:
Student *
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Invalid Input		 Day *
Invalid Input		 Time *
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Student
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Student
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Student
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Student
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RELEASE: By clicking SUBMIT, you agree that Billings Dance Center will not be held responsible for any lost or stolen property you may suffer on the premises. Though all precautions will be taken, we will also not be responsible for any injury that may occur during the normal operations of Billings Dance Center. This release applies to all terms of enrollment. I also give Billings Dance Center the right to use photographs taken during my family enrollment for publicity purposes. Clicking SUBMIT indicates agreement with Billings Dance Center tuition, students policies and responsibility for payment as outlined by the tuition plan.