ARTS FIFTH AVENUE REGISTRATION FORM
2013 Youth & Adult

Student Name: Address:

City:
State:
Zip:

Phone
Home:
Work:
Cell:

Email Address:

For Youth: Parents Name:

Youth Birthday (MM/DD/YY):

Adult Birthday (MM/DD):

Emergency Contact Name:

Emergency Phone:

Classes - please verify day/time of classes below:

Tap
Argentine Tango
Art 6-Week Workshop for Kids
Art 6-Week Workshop for Adults
Art Class for Ages 6 & Up
Burlesque Body Sculpt (BBS)
Home School Fine Arts Program
Intro to Dance
Summer Playhouse
Vocal Chorus
Yoga
Zumba

Private Lessons: Voice, Piano, Guitar, Tap, Trumpet,
Flute, Bass, Mandolin, Ukulele, & More.

(exact time to be scheduled/ instructor

Day of Week & /Time of Class(es):

Special Needs of Student: