Please register me for Fall/Winter/Spring Classes.

A $15 registraton fee is due within two weeks of this application to reserve a place in the program.
Please register me for the Summer Intensive

July 14 - Aug. 1, 2008
Other

A$25 non-refundable deposit is due within two weeks of this application. This will reserve a place in the program for your child and will be credited toward tuition. Payment must be received in full by June 1. A $25 discount may be applied if full payment by May 1.

Send deposit to:
Wissahickon Dance Academy, 38 E. Schoolhouse La., Phila. PA 19144
215-849-7950 (phone) 1-800-849-4919 (toll free) 215-849-3117 (fax)

First Name:

Last Name:
Parents Name:
Bill To:
Address:
City:  
State:
Zip:
School:
Phone:
Work Phone:
Cell Phone:
Emergency Phone:
Email:
Age:
Date of Birth:
Sex:
Height:
Weight:
Previous Dance School:
Previous Teacher:
Housing Needed:   Yes No
Class, Day, and Time: (Winter registrants only)
Ballet Background:
Comments:
 
 

38 East Schoolhouse Lane, Philadelphia, PA 19144

telephone: (215)-849-7950    fax: (215)-849-3117
toll free: 1-800-849-4919
email: wissahickondance@verizon.net