Summer Registration

Student Name:
Student Age:
Student DOB:
Parent Gaurdian Name:
Complete Mailing Address:


Day Phone:
Evening Phone:
Mobile Phone:
E Mail Address:
Emergency Contact:
Emergency Contact Phone:
Previous Experience:


Specials Needs:


Please let us know which class(es) we can expect to see you
at this summer:
Monday 5:00-6:00 ~ 3-4 yrs ~ Pre-Ballet/Tap
Monday 6:00-7:30 ~ 5-7 yrs ~ Tap/Ballet/Jazz
Wednesday 5:00-6:30 ~ 8-10 yrs ~ Tap/Ballet/Jazz
Dance Camp ~ 3-6 yrs July 6-10 1:00-4:00 PM

Monday 7:30-8:15 ~ Family Yoga ~ Ages 3-Adult (How many family
members will be attending?)

Wednesday 6:30-7:30 ~ Adult Tap or Jazz (enter preference for
style below) I would prefer: