Registration

Please register all family members on one form. (* indicates a required field.)

*Name of person completing registration:

*Student #1 Last: *First: *DOB *Grade

*Dance experience in years:Tap: Jazz: Ballet: Other:

Student #2 Last Name: First: DOB Grade

Dance experience in years: Tap: Jazz: Ballet: Other:

Student #3 Last Name: First: DOB Grade

Dance experience in years: Tap: Jazz: Ballet: Other:

Student #4 Last Name: First: DOB Grade

Dance experience in years: Tap: Jazz: Ballet: Other:

*Parents Name(s):

*Address: *City:

*State: *Zip:

*Home phone: Work phone: Cell phone:

*Email address:

Classes registering for:

*Student: *Class: *Day: *Time:

Student: Class: Day: Time:

Student: Class: Day: Time:

Student: Class: Day: Time:

Student: Class: Day: Time:

Student: Class: Day: Time:

Student: Class: Day: Time:

Student: Class: Day: Time:

Student: Class: Day: Time:

*Please select a method of payment (your placement in class is not guaranteed until payment is received.)

* Mail check to address at bottom of form. Pay by phone (Visa/MC/American Express)

Visa, MasterCard, and American Express are accepted by phone or at the studio.

Additional Comments / Questions:

How did you hear about Billings Dance Center? Select One Friend Referral Citysearch Website Portland Parent Beaverton Times Hillsboro Argus Tigard Times The Oregonian Superpages Verizon Yellow Pages Other

If you selected "Other", please specify:

Release:
Billings Dance & Performing Arts Center will not be held responsible for any lost or stolen property that may occur on the premises. Though all precautions will be taken, we also will not be held responsible for any injury that may occur during the normal operations of Billings Dance & Performing Arts Center. This release applies to all terms of enrollment. I also give Billings Dance Center the right to use photographs taken during my family's enrollment for publicity purposes. My signature below indicates agreement with Billings Dance Center tuition and student policies and responsibility for payment as outlined by the chosen tuition plan.

Signature of person responsible for tuition payment:
Date:

A signature of the person responsible for tuition payment is required to complete your registration. You can either print out this form and mail a signed copy with your payment or sign at the studio the first day of your class.

   

 

If mailing your payment, please mail to:

Billings Dance & Performing Arts Center
10160 SW Nimbus Ave., Suite F6
Portland, OR 97223