Extreme Performing Arts Registration Form
Please print and fill out a registration form for each student registering.

Student Information

Name_______________________________ Age____________ Grade_____________

Address____________________________ City__________________ Zip___________

Phone # ________________________________ Years of Dance Experience _________

Mother's Name__________________________ Work or Cell #____________________

Father's Name__________________________ Work or Cell #____________________

Emergency Contact ________________________ Phone #_______________________

Signature Release X______________________________________________________
(For Emergency Contact)

Class Choices for 2015-2016

Day    Time    Class ( jazz, hip-hop, etc...)
1.______________________________________________
2.______________________________________________
3.______________________________________________
4.______________________________________________

Mail or bring this form along with a check for
Registration Fee and 1st months tuition to:
Extreme Performing Arts
3950 F.M. 1488   
Conroe, Texas 77384

Payment Enclosed
Check #_______

*You should receive a confirmation letter after mailing in your registration form.  
Please call 936-321-1822 if you have any questions.