Hellenic Dancer Registration Form
Registration form and participation fee ($50 for members / $80 for non-members) is due by October 31, 2018.

Group Levels are as follows:
* BEGINNER ~ 4 year old Preschool through 2nd grade
* JUNIOR ~ 3rd grade through 6th grade
* SENIOR ~ 7th grade through 12th grade
* YOUNG ADULT ~ Past participants of the dance program

Name *
(First and Last name)
Your answer
School grade *
grade attending in the Fall 2018
Your answer
Please indicate dance level: *
Parent name(s) *
first and last
Your answer
Mailing Address *
include City / ZIP Code
Your answer
Home Phone
Your answer
Parent Cell Phone *
Your answer
Parent Email *
Your answer
Dancer Cell Phone (if applicable)
Your answer
Dancer Email (if applicable)
Your answer
Please list any allergies or medical condition instructors should be aware of:
Your answer
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