2011-12 Dance School Registration

You may fill out the student registration form below and submit it through the website today. After registration is completed you will be sent your billing statement and class information. You may also print a registration form above and submit it by mail or fax to us. Any questions please email us at info@jeannettesdanceschool.com

Student's Name:
Date of Birth:
Street Address:
Apartment Number:
Zip Code:
Home Phone Number:
Email :
Mother's Name:
Father's Name:
Emergency Name:
Emergency Phone Number:
Medical Problems:
Classes you'd like to attend	Tap Jazz Ballet All Three
The Day / Time of Classes	Date: Time: Date: Time:
NEW STUDENT REFERRED BY:
Comments

Please click the submit button when form is completed.  If you do not receive a confirmation  email within two days please contact us at info@jeannettesdanceschool.com 

Thanks, Jeannette