STUDENT’S NAME:___________________________________________AGE:____
ADDRESS:__________________________________________________________
CITY: ____________________________________________ZIP:______________
HOME PHONE #:_____________________________________________________
SCHOOL NAME:___________________________________________ GRADE:____
MOTHER’S NAME:____________________________________________________
CELL & WORK #:_____________________________________________________
E-MAIL ADDRESS:____________________________________________________
FATHER’S NAME:_____________________________________________________
CELL & WORK #:______________________________________________________
E-MAIL ADDRESS:____________________________________________________
PREVIOUS DANCE EXPERIENCE:_________________________________________
___________________________________________________________________
*RETURN THIS FORM WITH $20.00 REGISTRATION FEE
SIGNATURE:_________________________________________________________
(PARENT OR GUARDIAN-STUDENT IF 19 OR OLDER)
ReNance Dance Studio 5352 Chicago Av S Minneapolis, MN 55417 612-824-0848