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 2013-2014 Day    Time    Class ( jazz, hip-hop, etc...) 1.______________________________________________ 2.______________________________________________ 3.______________________________________________ 4.______________________________________________ Mail or bring this form along with a check for Registration Fee and 1/2 of the 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.