Broadway Dance Center
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Guardian must fill out this form for Applicant under 13 years of age.

GUARDIAN INFORMATION

Guardian Name  
Guardian E-mail    
Relationship to Applicant  
Home Phone
Work Phone
Other Phone (service, cell, beeper)
Preferred Contact Phone
APPLICANT INFORMATION
First Name  
Last Name  
Nick Name
E-mail  
Address Line 1  
Address Line 2
City  
State
Zip  
Country
Birth Date (mm/dd/yyyy)    
Gender
EMERGENCY CONTACT INFORMATION
(if different than Guardian info.)
Name
Phone
E-MAIL SUBSCRIPTIONS
Subscriber Letter
Yes, please subscribe the Applicant to the BDC email list. Subscribe to the BDC email list and keep up to date on all the current events and new programs at the studio through periodic emails directly from Allison Ellner, the CEO and Director of BDC! (If you are already a subscriber, please check this box to confirm your subscription.)
PRIVACY POLICY & RELEASE AGREEMENT
BDC does NOT share your email address with anyone outside of Broadway Dance Center. To learn more about BDC's use of personal information, please read BDC's Privacy Policy.
  I have read and agree to the terms of the Release & Waiver
  I have read and agree to the terms of the Privacy Policy