Registration Form

Anna Marie's Academy of Dance

REGISTRATION FORM

Complete this form and return as soon as possible with a $20.00 NON-REFUNDABLE registration Fee

Mail to:

Anna Marie's Academy of Dance

7201 Marsden Street

Philadelphia, PA

19135-1224

Student's Name
Address
City, State, Zipcode
Date of Birth
Parent/Guardian
Home Phone Number
Work Number
Cell Phone
Email
Type of Class(es) you wish to register for:
Have you attended dance classes in the past?
If yes, where did you study, which type of dance and how long?
How did you hear about our Studio?
In case of Emergency CONTACT:

7201 Marsden Street * Philadelphia, PA 19135-1224

(215) 332-3636

* TACONY * Northeast Philadelphia * Cottman Avenue Exit of I-95 *

* NE Corner of Wellington & Marsden Streets *