Wmsvl Online Registration Form

Please fill out and submit the form below to reserve a spot for your child. You will receive an email acknowledgment. This form is for the WILLIAMSVILLE studio only. Please use the Kenmore Online Registration form for the Kenmore location.

Please mail registration form of $10/ 1 student - $20/ 2 students - $25/ 3 or more students:

Jamie Kiefer

159 South Irwinwood Rd

Lancaster, NY, 14086

Visit our Online Payments Page to pay with Visa/MC/Discover

* Required fields
Name *
E-mail Address *
Parents' Names
Home Address
City & Zip
Home Phone Number
Alternate Phone
Date Of Birth
Age As Of September 2010
Any Allergies or Medical Conditions? If yes, please explain.
Classes Desired:
	Creative Movement Ages 2-3 Saturday 9:00-9:45AM
	Creative Movement Ages 2-3 Friday 10:00-10:45AM
	Preschool Combo Ages 3-4 Saturday 11:00-11:45AM
	Preschool Combo Ages 3-4 Wednesday 10:00-10:45AM
	Preschool Combo Ages 3-4 Friday 3:30-4:15PM
	Preschool Combo Ages 3-4 - Tuesday 5:00-5:45PM
	Kinder-Combo Ages 5-6 Saturday 9:45-10:45AM
	Kinder-Combo Ages 5-6 Monday 3:30-4:30PM
	Kinder-Combo Ages 5-6 Friday 4:15-5:15PM
	Jazz ages 6-7 Saturday 12:15-1:00PM
	Tap Ages 6-7 Tuesday 4:15-5:00PM
	Jazz, Ages 6-8, Friday 5:15-6:00PM
	Ballet ages 6-7 Saturday 11:30AM-12:15PM
	Ballet Ages 6-7 Tuesday 3:30-4:15PM
	Ballet ages 7-9, Monday 6:00-6:45PM
	Ballet Ages 9 &up, email for available times
	Tap ages 9& up, email for available times
	Jazz ages 9 & up, email for available times
	Acrobatics 5-7, Thursday 5:00-6:00PM, Currently FULL
	Acrobatics ages 6-9, Wednesday 5:00-6:00PM
	Acrobatics Intermediate Ages 9&up, Wednesday 7:00-8:00PM
	Hip Hop Ages 7-8, Thursday 4:00-5:00PM
	Hip Hop Ages 8-10, Wednesday 6:00-7:00PM
	Hip Hop Ages 11 & up, Wednesday 4:00-5:00PM
	Lyrical, ages 8 & up, email for available times
How did you hear about us?
Please describe any previous dance lessons
Questions or Comments?

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Your registration fee must be received within 10 days of online registration or your spot may be opened to another dancer. Any questions about class placement for your child, please call 563-2446 or email missjamiedance@yahoo.com

Thanks for registering! You will receive a mailed confirmation of registration upon receiving your registration fee.