Fall Registration Form (2010-2011)

Dancer's Name

Street Address

City

Zip

Home Phone

Student's Cell Phone

Email

Birthdate

Age

Year Started with Ann

School Name

Grade in School

Dancer's Height

Dress Size

Street Shoe Size

STUDIO WILL COMPLETE THE FOLLOWING SECTION

Studio Use Only: Bust

Studio Use Only: Waist

Studio Use Only: Hips

Studio Use Only: Girth

Studio Use Only: Inseam

Studio Use Only: Outseam

PARENT/GUARDIAN INFORMATION

Name of Parent/Guardian/Person Dancer Lives With

Address (if different from above)

City (if different)

Zip (if different)

Home Phone

Work Phone

Cell Phone

Parent's Email Address

Yes, email me the monthly newsletter!

EMERGENCY CONTACT INFORMATION

Emergency Contact Name

Relationship

Emergency Contact Phone Number(s)

ADDITIONAL INFORMATION

Names of other family members in dance

Please list any medical conditions the dancer has...

Student pickup instructions, if any

Please list any performance classes, if any

CLASSES & PAYMENT

List the classes you are registering for.

Annual enrollment fee is $25. Please select your payment method

I will call the studio with my credit card information.
I will bring payment to the studio during Early Enrollment.
I will mail my payment.

Early enrollment at the studio will be July 26-30 from 5:30-7:00 p.m.. Receive a 10% discount on your August tuition when enrolling and paying your tuition in full during early enrollment!

Upon submission, you will be redirected to the Liability Waiver. Your registration is not complete without this form.