REGISTRATION FORM
Eau Claire School of Dance
2007-2008

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Please check one:   ___ Eau Claire Studio    ___Menomonie Studio  __Chippewa Falls Studio

Student Name _______________________________________

Parent Name ________________________________________

Address ______________________ City/State/Zip_________

Phone Number ___________ Cell Number______________

Parent Email ______________ Student Email_____________

Grade In School _____ Birthdate _______ Age _______

Emergency Contacts:

Name_______________ Phone _____________ Cell________

Name_______________ Phone _____________ Cell________

Doctor _____________________ Phone __________________

Person Financially Responsible:

Name _____________________ Phone __________________

Address (if different from above)______________________

Parent Signature _____________________________________

Please sign me up for the following class(es):
  ____________________________________________________

____________________________________________________

Previous Dance Experience:
  ____________________________________________________

OTHER_______________________________________________

You will receive confirmation before September 1st.

THANK YOU FOR YOUR REGISTRATION!!!!!