Registration Form

PLEASE COMPLETE AND RETURN BEFORE MAY 3lst WITH $15.00 FEE. THE FEE WILL BE $18.00 AFTER MAY 31st FOR CURRENT STUDENTS. REGISTRATION FEE WILL REMAIN $15.00 FOR NEW STUDENTS.


STUDENT’S NAME ____________________________________________________________

AGE _____________________________


PARENT'S NAME _____________________________________________________________

PHONE ___________________________


ADDRESS ___________________________________________________________________

CITY/ZIP __________________________________________________________________


CLASS DAY AND TIME

1st CHOICE ______________________

2nd CHOICE ______________________


CLASS DAY AND TIME

1st CHOICE ______________________

2nd CHOICE ______________________

LIST ADDITIONAL CLASSES BY DAY AND TIME ___________________________________

___________________________________________________________________________

EMAIL ADDRESS _____________________________________________________________

TUITION RATE:_____________________

RETURN FORMS TO: EXCELLENCE IN DANCE
MIA KLINGER 1386 BUCKINGHAM GATE BLVD.,CUYAHOGA FALLS, OHIO 44221
E-MAIL: mia@klingers.us