Register

Student's Name *

Student's Last Name *

Phone *

Email Address *

Birth Date *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Emergency ContactMust provide an emergency contact

First Name *

Last Name

Phone *

Email Address *

Guardians Name/ Emergency ContactRequired if under 18

First Name 1

Last Name 1

Phone 1

First Name 2

Last Name 2

Phone 2

Photo/Video Release WaiverPlease sign our photo/ video waiver below. If under 18 parent/ guardian name & consent is required

Student's First Name *

Student's Last Name *

Parent/ Guardians First Name *

Parent/ Guardians Last Name *

Today's Date *

Dance

Beshkan Dance Academy

(408) 378-3234

Dance Boulevard

1824 Hillsdale Ave, San Jose, CA 95124