Registration Form 2010-2011 Dance Season

Name: _________________________________ Age:______________ Birthdate:__________________

Address: ___________________________________________________________________________

Home Phone: _______________________________Work Phone: ______________________________

Parents Names:______________________________E-mail: __________________________________

Years of Dance: __________ Type of Class: _______________________________________________

Class(es) Day/Time: ______________________________________________________________________

Other Comments/Requests: _____________________________________________________________

Please return this form with your $20.00 registration fee and first and last month's tuition to Dianne at your earliest convinence. Please print this form, fill it out, and mail it to:

D.D.'s Dance Studio
901 Cheri Lane
Mendota Heights, MN 55120