New Orleans Dance Collective

New Orleans Dance Collective
3705 St. Claude Ave.
New Orleans, LA 70117
ph: 504-491-2390
alt: 504-251-1556
janet@noladance.org

You must indicate if your registration is for weekly classes or for the Summer Dance Intensive

Please select which program you are registereing for below:

*REGISTRATION FOR

WEEKLY DANCE CLASS SUMMER DANCE INTENSIVE

SELECT ONE OR BOTH

*Student's First Name:

*Student's Last Name:

*Student's Address Line 1:

Address Line 2:

*City:

*State/Province:

*ZIP/Postal Code:

Student's Date of Birth

*Grade Level 2013

*Parent's Name(s):

Parent's Home Phone Number:

*Parent Cell Phone Number:

*Parent Email Address:

Student's Shirt, Pants, and Shoe Size

Please enter the student's shirt size first, pant size second, and shoe size third.

Emergency Contact(s)

Please enter the name and phone number of at least one emergency contact for the student.

Doctor's Name

Doctor's Phone Number

Allergies:

Need Assistance?

Please contact me.

janet@noladance.org

Special Conditions:

How do you prefer to be contacted?

Submit Your Message:

New Orleans Dance Collective
3705 St. Claude Ave.
New Orleans, LA 70117
ph: 504-491-2390
alt: 504-251-1556
janet@noladance.org