Ebony ExpressionZ Company
2017-18 Company Team Registration Form
705 S. MAIN STREET, Suite C., LANCASTER, SC 29720
Email address *
Student Name *
First Name & Last Name
Your answer
Mailing Address (include city, state and zip code) *
Your answer
Student Age *
Date of Birth
Your answer
#2 Student Name
First & Last Name
Your answer
#2 Student Age *
Date of Birth
Your answer
Please list years of experience.
Include genres of dance he/she has learned.
Your answer
Parent/Guardian Name *
List first and last name
Your answer
Phone Number *
Area code
Your answer
Emergency Contact 1 *
List First & Last Name with Phone Number
Your answer
Emergency Contact 2 *
List First & Last Name with Phone Number
Your answer
Tuition Statement (please check the box for acknowledgement) *
Required
Required Rehearsal Attire Checklist (no selection required, this is for your information only)
Rehearsal Attire Statement (please check the box for acknowledgment) *
Required
CLASS DAYS & TIMES
WEDNESDAY 6:30PM - 8:00PM
FRIDAY 6:30PM - 8:00PM
Saturdays optional classes may be scheduled from 11:00-12:30pm

Location: 705 S. Main St., Suite C., Lancaster, SC 29720

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