American Dance Institute

Elizabeth Chayer, Director
8001 Greenwood Ave N (Studio #1)
8007 Greenwood Ave N (Studio #2)
Seattle, WA 98103 206-783-0755
Office is located in annex behind Studio #1

Download Form

Participant Information If you are registering more than one student, please submit as a separate registration. Thank you.
First Name:		Email:
Last Name:		Home Phone:
Date Of Birth:		Work Phone:
Parent #1 First Name: (if student under 18)		Parent #1 Last Name:
Parent #2 First Name: (if student under 18)		Parent #2 Last Name:
Cell Phone:		Emergency Contact:
Address:		Emergency Phone:

City:
State:
Zip Code:

Returning Student:
New Student:
Physical Limitations:

Registering for:

How did you hear about us?

Drive By/Walk By
Internet
Yellow Pages
Auction Gift Certificate
Phinney Ridge Review
Parent Map
Baby Map
Groupon or other online coupon
Friend/Relative:
Other


	Yes, I give my permission for my/my child(ren)’s image to be used by American Dance Institute (ADI) for ADI's official website, and/or in print for the purposes of advertisement and promotion of ADI, and/or advertisement and promotion of any special event by/for ADI.

	No, I do NOT give my permission for my/my child(ren)'s image(s) to be used by American Dance Institute for any purpose.

If you are registering more than one student, please submit as a separate registration. Thank you.