Class Registration Form
Please use a separate form for each student
Name of Student________________________________Birth Date____________________
Name of Parent(s) or Guardian________________________________________________
Street Address_______________________________________________________________
City___________________________________State__________Zip Code_______________
Daytime Phone_________________________Evening Phone__________________________
Email________________________________________________________________________
Please list all classes you wish to enroll in:
(use back if additional room is needed)
1.______________________________________2.___________________________________
3.______________________________________4.___________________________________
5.______________________________________6.___________________________________
Total number of hours enrolled this student__________________________________
Total number of hours enrolled all students in family combined_____________________
Method of Payment: (check one)
________ I am paying by check or money order
_______ I am using my credit card(check one) _______Visa _______Master Card
Card Number:______________________________VIN_______Exp Date:_________
(3 digit code from back)
Signature__________________________Printed Name_________________________
______Full Payment is Enclosed.
______$25.00 Holding Deposit Enclosed. Full Payment by Sept 10th.
______Four Monthly Payments. First Month's Payment is Enclosed.
Make checks and money orders payable to: Dancer's Studio
|