ENROLLMENT FORM: GRANBY STUDIO
Student's Name:_______________________________________________________
Age as of Sept. 1:_____ Date of Birth:______________________________________
Street Address:________________________________________________________
City, State & Zip:_______________________________________________________
Telephone No:(______)__________________E-Mail:____________________________
Class Day & Time:_______________________________Instructor:_________________
Class Day & Time:_______________________________Instructor:_________________
Class Day & Time:_______________________________Instructor:_________________
Class Day & Time:_______________________________Instructor:_________________
Class Day & Time:_______________________________Instructor:_________________
Parent's Name:________________________________________________________
I understand that dance and gymnastics involves twisting and turning, and injuries may result. All families are responsible for their own medical coverage and insurance. I also give permission for any dance pictures to be used in local newspaper articles, studio advertising or on our web-site.
Signature___________________________________Date:______________________


Each Granby student must pay a $20 nonrefundable registration fee.
Please enclose this completed form along with a nonrefundable check for September lessons plus the Twenty dollar ($20.00) registration fee and return to...
New England Dance and Gymnastics Centers
11 Mill Pond Drive
Granby, CT 06035

     Amount enclosed- $_____________

Where did you hear about us?___________________________________________________