New Heights Theatre Dance Academy & Music Center
Student Registration Form September 2009 - June 2010


Last Name:
First Name:
Date of Birth:
Parent's Name(s):
Street Address:
City, State, Zip Code:
Phone:
E-Mail:
Parent's Work Phone:
In Case of Emergency Phone:
Previous Training:
Studio Name:
City/State:
Years of Training:

Release: I agree to adhere to the policies and guildlines set forth by New Heights Theatre Dance Academy &
Music Center (NHTDA). I understand that all photographs and images taken throughout the year are property of
NHTDA and may be used for advertising or promotional purposes.

Parent/Guardian signature:

Date:

There is a Yearly $15.00 Registration Fee per Student, $25.00 per Family (Non-Refundable)

Choose from the following (Please circle below):

PRE-SCHOOL DANCE, PRE-BALLET, PRE-TAP/JAZZ, INTRO TO HIP-HOP, INTRO TO LYRICAL
BEGINNER BALLET, BEGINNER TAP/JAZZ, BEGINNER HIP-HOP, BEGINNER LYRICAL
HIP-HOP, LYRICAL, BALLET, *POINTE, TAP/JAZZ
ADULT BALLET, ADULT TAP, ADULT JAZZ

BASS GUITAR, CELLO, GUITAR, MANDOLIN, VIOLIN, FLUTE, CLARINET, SAXOPHONE, TRUMPET,
TROMBONE, PIANO, VOICE, OTHER INSTRUMENT (________________________________)
MUSIC & MOVEMENT, MUSIC MAKERS, CHORUS, GROUP PIANO (CHILD)
GROUP PIANO (ADULT), FILMMAKING, MUSICAL THEATRE, MUSIC THEORY

*Enrollment in this class is by Artistic Director approval only