Please fill-out, print, and mail to:
Dance Theater West
3925 E. Indian School Road
Phoenix, AZ  85018
New students: Please include a $15 registration fee for the class.
All fees are due by the first day of class.
Checks should be made out to Dance Theater West.

Dancer's Name _______________________________________________________________

Parent's Name ________________________________________________________________

Street Address: ________________________________________________________________

City: ____________________________ State ________  Zip Code_______________________

Home Phone Number:________________________ Work or Cell: ________________________

email address: _________________________________________________________________

Class Title: __________________________________ Day:______________ Time: ___________

Class Title: __________________________________ Day:______________ Time: ___________

Class Title: __________________________________ Day:______________ Time: ___________

Class Title: __________________________________ Day:______________ Time: ___________

Class Title: __________________________________ Day:______________ Time: ___________

Class Title: __________________________________ Day:______________ Time: ___________

Class Title: __________________________________ Day:______________ Time: ___________

Class Title: __________________________________ Day:______________ Time: ___________


Amount $ enclosed: _______________________________   contact information will not be released to outside agencies