Registrations  

       Students Name: 

                      D.O.B.    AGE:

Guardian (if under 18)

                    Address:    City:     Zip:

                       Email:       Phone:     Work:

         Health Concerns: Choose One Yes No

            Please Explain:

Below please tell us who can pick up your child (please specify) : If Applicable

                Interest 1:  Choose one Hip Hop Ballet Jazz Contemporary Line Dance Fitness Music Ballroom Yoga Belly Dance    Interest 2: Choose one Hip Hop Ballet Jazz Contemporary Line Dance Fitness Music Ballroom Yoga Belly Dance

                   Message: