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2008-2009 CHEERDANCE Academy Performing Arts Center Registration Form

Parents/Guardians Names: *

Parents Email: *

Home Address: *

City: *

State: *

Zip Code: *

Home phone: *

How did you hear about us? *

Cell phone:

Medical Insurance Company:

Policy Number:

Emergency Contact Name and Phone number: *

Student #1 Name: *

Student #1 Birthdate: *

Student #1 School:

Student #1 Grade:

Student #1 T-shirt Size *

Student #1 Shorts Size *

Student #2 Name:

Student #2 Birthdate:

Student #2 School:

Student #2 Grade:

Student #2 T-shirt size:

Student #3 Name:

Student #3 Birthdate:

Student #3 School:

Student #3 Grade:

Student #3 T-shirt size:

Annual Registration fee = $50
(Family Discount for siblings! Registration fee = $25 each add'l student!)
(FREE t-shirt and shorts with registration)
Pay Now and save $5!
August 10th to August 16th Student #1 Registration fee = $45
After August 16th Student #1 Registration fee = $50.00
To PAY NOW, go to "Pay Registration fee online"
(Signature required for waiver and policys to complete registration)