cricketsperformingarts@gmail.com
1 North Main St. Manheim PA 17545
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Student Registration
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Student Name
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Birthdate
Address
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Street Address
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Phone
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First year enrolled at Cricket's
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Please provide year for each student registering
Student Name
First Year Enrolled
Total Years of Dance Experience
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Please provide total years of experience for each student registering
Student Name
Total Years
Style of Dance Previously Enrolled in
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Please list the style of dance your student(s) has been previously enrolled in
Dance Style
Classes of Interest
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Combo (Ballet + Tap)
Ballet
Tap
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Musical Theater Dance
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Individual Responsible for Payments
*
First
Last
Contact Phone Number
Mother's Name
First
Last
Mother's Phone Number (home)
Mother's Phone Number (Cell)
Father's Name
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Last
Father's Phone Number (Home)
Father's Phone Number (Cell)
Emergency Contact
*
Name
Relationship
Phone (home)