Fall Registration                                                                    DATE___ /___ /___

STUDENT NAME: FIRST_______________LAST________________________

MOTHER NAME: FIRST________________LAST_______________________

FATHER NAME: FIRST________________LAST________________________

STUDENT ADDRESS_____________________________________________________

CITY___________________STATE________ZIP___________

STUDENT HOME (_____) ______-________ STUDENT CELL (____)_____-_______

MOTHER CELL (_____) ______-________    FATHER CELL (____)_____-_______

****EMAIL___________________________________________________________

STUDENT BIRTH DATE ___/___/____     STUDENT AGE ______

SCHOOL ATTENDING___________________________________________________

PHYSICIAN__________________________PHONE # (____)_____-_______

CHECK TYPES OF SUBJECTS DESIRED

BALLET ____                      HIPHOP____                      JAZZ____ 

TAP ____                            MODERN____                 POINTE_____

 GROUP____                  PRIVATE____            SEMI-PRIVATE_____

FILL IN CLASSES DESIRED AS LISTED ON SCHEDULE:

CLASS________________________________DAY______________TIME__________ CLASS________________________________DAY______________TIME__________ CLASS________________________________DAY______________TIME__________

CLASS________________________________DAY______________TIME__________

CLASS________________________________DAY______________TIME__________

CLASS________________________________DAY______________TIME__________

CLASS________________________________DAY______________TIME__________

CLASS________________________________DAY______________TIME__________

CLASS________________________________DAY______________TIME__________