Registration Form

2012-2013 Registration

Student's Name:*

Student's D.O.B: *

Age:

Parent/Guardian's Name: *

Email Address: *

Street Address:

City: *

Zip Code: *

Home Phone:

Father's Occupation:

Father's Work Phone:

Mother's Occupation:

Mother's Work Phone:

How did you hear about us: *

Previous Dance Experience:

Class Requesting:

FIRST CHOICE: *

SECOND CHOICE:

I agree to the Terms and Conditions. TERMS AND CONDITIONS

<<	May 2013					>>
Sun	Mon	Tue	Wed	Thu	Fri	Sat
			1	2	3	Picture Day - studio OPENX Picture Day 4
Picture DayX Picture Day 5	6	7	8	9	10	11
12	13	14	15	16	17	Benefit Show 7:00X Benefit 18
19	20	St. Ann'sX St. Ann's 21	22	Cherry RidgeX Cherry Ridge Senior Center 23	24	25
26	Memorial Day closedX Memorial Day 27	28	29	30	31

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