2020-2021 Student Registration Form
A one time registration fee of $20 per family is due for new students. Returning families who did not register prior to June 20, 2020, will be charged a $10.00 registration fee. Please send your check made out to the Blair Dance Center to: 8738 Raven Oaks Drive Omaha, NE 68152 We must have this registration fee to hold your child's place in class.
Please Choose One
New Student
Former Student
Student Name
First Name
Last Name
Student Birthdate
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade in School
New Students: Please list any previous dance experience.
Parent/Guardian #1
First Name
Last Name
Email #1
example@example.com
Phone Number
Format: (000) 000-0000.
Parent/Guardian #2
First Name
Last Name
Email #2
example@example.com
Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate any add on classes you interested in joining.
Pom - Grades (1-12)
Hip Hop Grades 2-4)
Clogging (Grades 4-12)
Pointe (Begins 6th grade upon approval)
Liturgical Dance (Grades 4-8)
Please list any medical conditions or allergies
To help with scheduling, please list any conflicts . days/times
I can make a class time before 5:00.
Yes
N0
Other
Submit
Should be Empty: