Registration Form 2008                   

Student Name: (last name) (first name)

Parent/Guardian/Account Information:
(all bills are the responsibility of parent or guardian for the students under age 18)

Last First Relationship

Last First Relationship

Address City State Zip

Phone Information: Home Work Cell

Pager Alternate Home Phone Who's phone

Student Information: (Last name) (First Name)

Address (if different) City State Zip

Registration date Birth date

Is student a member of Competitive Dance Company? Yes or, No

Emergency Contact information: (These numbers will only be used in the event of an emergency)

Phone # Name Relationship

phone # Name Relationship

Classes applied for: (Please check the appropriate categories below)

Tiny Tots | Acro | Acro/Combo | Jazz | Jazz/Combo | Adult Class | Tap

Tap/Combo | Lyrical | Ballet | Other | Hip Hop