2017 - 18 Registration Form 

First Name______________________

Birth Date______________ Age_____

Parent's Name___________________

Mailing Address__________________

Home Phone_____________________

Mother's Name___________________

Father's Name___________________

Last Name______________________

Grade_______ School_____________

Email __________________________

City _______________ Zip_________

Cell Phone______________________

Work Phone_____________________

Work Phone_____________________

Please mark the classes desired and the years of previous training.

Pre-Ballet ___ ___    Ballet ___  ___    Pointe (Pre) ___  ___  Acrobatics ___  ___   Jazz (Pre) ___  ___   
Modern ___  ___   Tap  ___  ___    St. Assistant ____    Performance (Grades 3-6th)  ____ ____

  Special Requirements:

FL License #_____________________

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Please Print Out This Form and mail it or bring it in to the studio
Students have not attended classes in the previous year are considered new. This is to be remitted with the registration form.

Mail your registration form to:

Blackwood Studios, Inc.
37747 Meridian Avenue - Dade City, Florida 33525
Please call (352) 567-5919 or email blackwoodstudios @ gmail.com 
for more information.

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