School Year Registration - Bonnie Haney School of Dance and Performing Company

Today's Date*

Dancer Information

Name*

First Last

Sex*

Female
Male

Address*

Street Address City State ZIP Code

Preferred Email*

Home Phone*

(xxx) xxx - xxxx

Age*

Birth Date*

Grade

School

Have you studied dance before?

Yes
No

If yes, where did you study dance?

Please describe what type(s) of dance and how many years:

Do you have experience in any dance-related activities? Please explain.

(i.e. Gymnastics, Cheerleading, Musical Theatre, etc)

Classes

Please select the class(es) that you are interested in.

Ballet

Younger classes are a combination of Ballet basics and creative movement activities. Level 1, 2 & 3 classes are held twice a week, and members of all levels are welcome and encouraged to attend all 3 classes each of these days with no extra charge. Level 2 & 3 students are introduced into pointe when/if they are ready.

List of our Ballet classes

Mon/Wed 5:00-5:45 | Ages 6-10 Ballet 1/2 *
Mon 5:45-6:40 | Ages Teen-Adult Beg. Ballet 2/3 *
Monday 7:45-8:45 | Ages Teen-Adult Beg. Ballet *
Tuesday 5:15-6:00 | Ages 3-6 Creative Ballet *
Tuesday 6:00-6:45 | Ages K-2nd Grade Pre-Ballet 1/2 *
Tuesday 6:45-7:40 | Ages Teen-Adult Ballet 1/2 *
Thursday 6:00-6:45 | Ages 3-6 Creative Ballet 1/2 *
Saturday 12:00-12:45 | Ages 3-6 Creative Movement/Pre-Ballet 1/2

Jazz / Hip-Hop / Lyrical

Each class will work on elements of all of these styles and will learn dances in each style as well.

List of our Jazz / Hip-Hop / Lyrical Classes

Tuesday 7:45-8:45 | Ages Teen/Ad Jazz/Hip-Hop/Lyrical 1/2
Thursday 5:15-6:00 | Ages 3-6 Creative Jazz/Hip-Hop 1/2 *
Thursday 6:45-7:40 | Ages 8-15 Jazz/Hip-Hop/Lyrical 1/2 *
Thursday 7:45-8:45 | Ages 11-Ad Dance Exercise 1/2 *
Saturday 12:45-1:30 | Ages 7-10 Jazz/Hip-Hop/Lyrical

Tap / Irish

List of our Tap and Irish Classes

Mon 5:45-6:40 | Ages 8-Ad Irish 1/2
Monday 7:00-8:00 | Ages Teen-Adult Tap 1/2
Tuesday 5:15-6:00 | Ages 6-10 Tap 1/2 *
Tuesday 6:00-6:45 | Ages 3-6 Creative Tap 1/2 *
Tuesday 6:45-7:40 | Ages Teen-Adult Tap 2/3
Wednesday 7:45-8:45 | Ages 11-Adult Tap 2/3
Saturday 1:30-2:30 | Ages 3-6 Tap 1/2
Saturday 2:30-3:30 | Teen/Ad Tap 1/2

PAYMENT

Form Of Payment*

Paypal

To pay online click here.

How did you hear about us?*

Parent / Guardian Info

Mother's Name

First Last

Fathers's Name

First Last

Marital Status

Seperate
Married

Mother's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Father's Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mother's Work Phone

(xxx) xxx - xxxx

Mother's Cell Phone

(xxx) xxx - xxxx

Mother's Email

Father's Work Phone

(xxx) xxx - xxxx

Father's Home Phone

(xxx) xxx - xxxx

Father's Cell Phone

(xxx) xxx - xxxx

Father's Email

Person Responsible for Payment

Please select one of these options*

Dancer
Mother
Father
Either Parent
Other (If you select other please fill out the information below)

Name

First Last

Relation

Address

Street Address City State ZIP Code

Home Phone

Cell Phone

Work Phone

Email

Emergency Contact Information

In case of emergency, who can we contact other than the parents/guardians listed above.

Name*

First Last

Relation*

Address*

Street Address City State ZIP Code

Home Number*

(xxx) xxx - xxxx

Cell Phone

(xxx) xxx - xxxx

Work Phone

(xxx) xxx - xxxx

Does dancer have insurance?*

Yes
No

If Yes what company?

Do you have any health concerns or past injuries?*

Yes
No

*If yes, please explain.

I give permission to Bonnie Haney Dance to take photos and/or videos of my dancer. These photos/videos may be used for advertising purposes and/or posted online.*

Yes
No

Email

This field is for validation purposes and should be left unchanged.