![]() Mail to: 650 Iwilei Rd. Box 221 Suite 295 Honolulu, HI 96817 Please! One Payment/registration per student |
Age __________________ Birth date ________________________ Dancer's School ________________________________ Grade ____________________ Dancer's Cell____________________ Email ____________________________________ Years ___ Ballet School _________________ Teachers _________________________ Parents' Email ____________________________________________________________ Mother's Name ___________________________________________________________ Business Company Name __________________________________________________ Home phone ___________________ Cell ________________Work _________________ Mailing address ___________________________________________________________ City _____________________________Zip ____________ Father's Name ___________________________________________________________ Business Company Name _________________________________________________ Home phone ___________________ Cell ________________Work _________________ Mailing address ___________________________________________________________ City _____________________________Zip ____________ Other Contact Name ______________________________________________________ Cell Phone _____________________ Work ____________________________________ New Students pay an additional $25 registration fee Class desired Location: Dole Cannery _______ Wahiawa _______ Kapolei _____ Credit Card #_______________________________________________ Exp Date ___________ Signature_________________________________________ FOR OFFICE USE: CC ______ Amt. paid ______ Ck # ______ Date paid ______________ |