PRINCE WILLIAM DANCE ACADEMY                                                                               Summer 2008 STUDENT  REGISTRATION    Print this form and mail to: PWDA,  P.O. Box 417, Nokesville, VA 20182-0417   For best results, browser text size should be no higher than Medium; Print Margins= 0.5 inch    Student Name_______________________________ Age  _____________  Date of Birth ________________    School Grade ___________ Name of School ________________________ Home School Student? Yes  No    Parent /Guardian Name _____________________________________________________________________    Address   _____________________________________________ City/ State/ Zip ______________________    (H) Phone  ___________________  E-Mail Address _____________________________________________    (W) Phone ____________________                 Cell Phone 1 _____________________           Cell Phone 2 _____________________         Previous Dance Experience (New Students)    Heard about PWDA from: Newspaper____ Friend ____ Mailer ____ Drove by ____ Website _____ PhoneBook _____ Other:    What should we know abour your child? (Allergies, medical conditions, temperament, etc.)     Class                         Day/Time                          Fee         MC/Visa Credit Card payment: All information is required    ____________________________________________ MC/Visa Credit Card # ___________________________    ____________________________________________ Expiration Month _______________ Year ____________       ____________________________________________ Zip Code _____________ Total Amount ______________    ____________________________________________ Signature ______________________________________    ____________________________________________                         >   >     Make Checks Payable to: Prince William Dance Academy or complete Credit Card information    Office Use Only: Payment Total _____________ Check #__________ Cash ___________ MC/Visa________________ Date______________