Beth Walsh Dance Centre Online Registration

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Welcome to Beth Walsh Dance Centre! We look forward to meeting your child's Dance needs. Please complete the following registration form. Any questions regarding class placement or tuition fees please contact Miss Beth at tinsleydance@aol.com for assistance. #keepondancin

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Referral Information

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Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info
(Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

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Work #

Cell # *

Portal Access (your email is your login)

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Contact #2

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Student #1

Student's First Name*

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Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Please click on the Search button below, then choose the class. Classes are grouped by Age and style... Preschool- Adult ... Competition Program offered in Pre-teen, Junior and Senior Class levels with consent of Miss Beth...email her at tinsleydance@aol.com for more information. Students may enroll in competition classes with Miss Beth's approval if they are at the appropriate skill level and are not interested in participating in competitions at this time.

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Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

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Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email*

T-Shirt Size

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

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Student #1

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