Summer Class 2009

Registration Form

Child’s Name:_________________________________

Age:_____________ Birthday:_________________

Parent’s Name:_______________________________

Phone Number:(home)______________ (cell)_________________

(work)________________

Emergency Contact:___________________________

(In case parent cannot be reached)

Phone number(s):_____________________________

Years of dance experience: ____ Ballet ____ Tap

___ Jazz ____ Hip Hop ____ Acro

Amount paid $________

Check Number ________