Barfield School of Dance Register

Dance Class

Registration
Dancers Name

First NameLast Name
Parent Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Format: (000) 000-0000.
Mobile Number
Format: (000) 000-0000.
E-mail
example@example.com
Dancers Age
Dancers Birth Date

MonthDayYear
Dancers Gender
Special Requests
How did you hear about us?
What are the best days for your schedule?
PLEASE SELECT YOUR PREFERRED DAY AND WE WILL SCHEDULE YOUR DANCER ACCORDINGLY. IF A CLASS IS UNAVAILABLE ON YOUR PREFERRED DAY, WE WILL CONTACT YOU VIA EMAIL. TO COMPLETE YOUR REGISTRATION, PLEASE SEND PAYMENT THROUGH ONLINE BILLPAY TO THE ADDRESS BELOW. THE NON-REFUNDABLE FEE IS $50/STUDENT. REGISTRATIONS NOT PAID WITHIN 30 DAYS WILL BE INACTIVATED.

Barfield School of Dance
2298 Barfield Road
Murfreesboro, TN 37128

barfieldschoolofdance@gmail.com
Date

MonthDayYear
Date
Should be Empty:

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