Banks Performing Arts Dance
                     Academy

14175 NW Sellers Rd Banks Or 97106 phone #503-324-0112

Banks Performing Arts Dance Academy                                    

14175 NW Seller Rd, Banks, Ore 97106                                       503-324-0112                                                                                                                                                                                          

Registration form:

Classes subject to change due to enrollment:

Student information:                                                                                                                                                                                                                                                                                         Student Name (Print )_____________________________/___/____    ____      _____                                                                                                      DOB          age    yrs training   

Student over 10 years, signature of commitment______________________date___/____/___   

Street Address______________________________  ___________  ______   ______                                                                                                                               City       State           Zip             

home phone: ________________Mom's cell____________________________       

dad's cell    _____________________________Email _________________________                                           

_________________________________    ______/__/___/__                                                         Guardians name  (Print)                                                        date           

 I have read the studio policy and understand before signing below:

______________________________________________ guardians signature_____/___/___/                                 :                                                                                                                               date           

how did you here about us__________________________________________

_____________________________________________________________________

____________________________________________________________________

  School year reg____

Performances:  yes __ no__          Performance 1st weekend in Dec                                                                                              and end of school year                                                                                 When performing I will not miss classes near the performance______                             

Registration: $15 make checks to Dian Punzel not the School                                                       Mail to 14175 NW Sellers Rd, Banks OR 97106.    

Please write in the classes you or your child will be attending, and mail or drop in the office with your registration fees                                                        

                days                          time                                        level

Ballet  _________________________________________________________________                        

Tap         ______________________________________________________________

Jazz        ________________________________________________________________

 Students ages may vary,with prior training they may be in a class with                                       older students.

         Fees: ( add all family members hour together for a sizable discount.