Name:
 Mailing Address:
 Town/City & State:
 Zip Code:
Home Phone:
 Cell Phone:
 Emergency Phone:
 Email Address:
Classes Attending:
      
Medical Conditions:
 Payment Type and Date:
 Payment Amount Enclosed
 Signature:
Academy of Dance Arts
Printable Registration Form
2010-2011
203-775-1331
By signing this form, I accept any and all responsibility associated with participation in this program,
and agree to abide by all of the rules, regulations and policies set forth by the Academy of Dance Arts.   
Please mail registration form and
complete payment to:

Academy of Dance Arts
336 Federal Road
Brookfield, CT  06804