Registration Form

Payment Information

We accept cash or checks. Please make checks payable to "Broadway Bound".

Payments can be sent to or dropped off at:
10580 Loveland Madeira Road
Loveland, OH 45140

Student's Name:*

Parent(s) Name:*

Email:*

Address:*

Phone:*

Date of Birth:

Gender:

Years of Dance Experience:

How did you hear about Broadway Bound Dance Academy?:

Please list First Choice Class/Day/Time: (You can list multiple classes.)

Please list Second Choice Class/Day/Time: (You can list multiple classes.)

Comments/Questions:

I agree to the terms & conditions in the Student Waiver. I have had adequate opportunity to read and understand it, and any questions have been answered to my satisfaction.

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