Student Name
Date Of Birth
Age
Address, City, Zip
Parent/Guardian Name
E-mail Address
Contact Telephone
Cell Phone
Emergancy Contact Name
Emergancy Telephone
Emergancy Cell Phone
February Vacation Dance Camp Registration 2012
Please Check All The Days You Are Signing Up For:
Full Payment is Due No Later Then
Monday February 13, 2012
please mail it, or drop it off at the studio.
Please List Any Allergies:
Please List Your Doctors Contact Info (in case of emergancy)
