Registration Form

Date:________________________

Name:___________________________ Age:______ DOB__________________

Address:________________________________________________________________

City: _________________________State:_____________ Zip:_____________________

Home Phone:_________________________

Parents Names:________________________________________________

Work Phone:__________________________________________________

I would like to be enrolled in:

Beginner____ Intermediate_____ Advanced_____ Not sure_______

____ Tiny Tots (18 mo.-2 yrs)

____ Creative Dance (3-4)

____ Creative Too! (5-6)

____ Ballet/tap combo

____ Jazz/tap combo

____Ballet ____Break/lock/pop ____Senior citizen soft shoe

____Point ____Acrobatics ____Acting

____Tap ____Swing ____Voice

____Jazz ____Lyrical

____Hip Hop ____Yoga

____Pilates mat work

Where did you hear about us?

Friend/word of mouth___ Sign____ Ad_____ Publication____ Other_____

Please list below previous dance education and experience (NEW STUDENTS)

STUDIO LENGTH OF STUDY

_______________________________ __________________________

_______________________________ __________________________

_______________________________ __________________________

Is there a class not listed in which you are interested?____________________________________________