Rockport Dance Conservatory
PO Box 126, West Rockport, ME 04865

Registration

Student Name:____________________________________ Birth Date:_____________

Home Phone:_________________ Email:___________________________________

Billing Parent Name:____________________________________________________

Parent #2 Name:_______________________________________________________

Home Phone:_____________________ Cell:___________________ Work:___________________

Home Address:__________________________________________________________________

I wish to enroll my student in the following classes:

DAY

CLASS

TIME

1)_______________________________________________________________________________________

2)_______________________________________________________________________________________

3)_______________________________________________________________________________________

4)_______________________________________________________________________________________

5)_______________________________________________________________________________________

6)_______________________________________________________________________________________

Total classes per Week:__________________

COST:
1 Class per week $12.00
2 Classes per week $11.00
3 Classes per week $10.00

Session ____Weeks

Total class per week _________ x session weeks______x class cost ______________
Registration Fee is $10.00 (once annually)