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SUMMER WORKSHOP ENROLLMENT FORM: WESTFIELD STUDIO
Student's Name:_______________________________________________________
Age:_____ Date of Birth:________________________________________________
Street Address:________________________________________________________
City, State & Zip:_______________________________________________________
Telephone No:(______)__________________E-Mail:____________________________
Workshop Date & Time:___________________________________________________
Instructors:____________________________________________________________
Workshop Date & Time:___________________________________________________
Instructors:____________________________________________________________
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:______________________
Total Price of Workshops- $___________

Please enclose this completed form along with a nonrefundable check for the cost of the
Summer Workshop and return to...
New England Dance and Gymnastics Centers
28 Southwick Road 
Westfield, MA 01085
      Amount enclosed- $____________