2010-2011Class Registration

Southern Sensations

Dance Studio

Child's Name_____________________________________

Age________      Birthday_________________

Parent's Name_________________________________________

Address______________________________________________

Home phone #__________________   Cell #_________________

Email address:_______________________________

Years of Dance Experience:   

Ballet_________            Tap__________     Jazz___________   Acro___________

Hip Hop_________                                              Total Years of Experience:_________

Emergency Contact Information (in case parent cannot be reached)

Name___________________________________________

Home #________________________                   Cell #____________________