ENROLLMENT FORM

CHILD CARE FACILITY/AREA ________________________  DANCE START DATE____________

STUDENT NAME____________________________________________________________________
                                              Last                            First                                   Birth Date (Month/Day/Year)

HOME ADDRESS____________________________________________________________________

                                             Street                          City                                    Zip

PARENT NAME_____________________________________________________________________
                                             Last                             First

PHONE____________________________________________________________________________
                                             Home                          Work

Please check one: ____Male ___ Female       Parent’s Email:______________________________________
 

Would you like to receive special announcements and bulletins via email?   ____Yes ___  No 

Was your child previously enrolled at WEBBY Dance Company?  ____Yes ____ No
 

INDICATE T-SHIRT SIZE:        ____ Child X-Small (2-4)     ____ Child Medium (10-12)
(Included with Registration Fee)    ____ Child Small (6-8)         ____ Child Large (14-16)
 

Please mail this form with registration fee and first month’s tuition payment to:
WEBBY Dance Company, 6975B Dixie Highway, Fairfield, OH 45014
Tuition can be pro-rated for students starting mid-month.