Brian Sexton Academy of Performing Arts 

 
  

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New Student Registration Form

Sexton Academy

Please Fill out the Registration form.

Please Fill Out the Following Registration form:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Cell Phone:


Emergency Contact:


Emergency Phone:


Students Name:


Student Birth date:

-- dd/mm/yy

Classes Requested:

MDL- Irish Step Beg Child       MDL- Irish Step Adv Child       Freehold -Irish Step Beg Child  Freehold-Irish Step Adv Child      
SPL - Wed Irish Step Beg Child  SPL - Sat Irish Step Beg Child  SPL - Irish Step - Adult Beg    SPL - Irish Step - Adult Adv  
SPL - Spanish Flamenco          SPL- Ballet

Any Prior Dance experience


Any Medical Conditions?


BSID
Copyright © 2005-6  Sexton Academy. All rights reserved.
Revised: 06/13/07

 

    
BPS Last Modified :01/06/08 11:02 PM Copyright 2002 - 2007
    
BPS Last Modified :01/06/08 11:02 PM Copyright 2002 - 2007