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.___________________________________
7.______________________________________8.___________________________________
Total number of hours enrolled this student____________________________________
Total number of hours enrolled all students in family combined_________________
Method of Payment: (check one)
________ check or money order
_______ credit card(check one) _______Visa _______Master Card ______ Discover
Card Number:______________________________
Exp Date:_________
V-code on back of card (3 digits) ________
Signature_____________________________Printed Name_______________________________
______Full Payment is Enclosed.
______Four Monthly Payments. First Month's Payment is Enclosed.
______I am sending the first months payment but intend to pre-pay by September 15th.
______ I have enclosed the $25.00 registration fee for new students.
Make checks and money orders payable to: Dancer's Studio
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