2010 - 11 Fall Registration

Student Name
Age (as of 9/1/10)
Grade
Dance Class Day & Time
Parent Name
Address
City
State
Zip Code
E-Mail Address
Home Telephone
Work Telephone
Cell Phone
Which number should you be contacted at in the daytime	Home Work Cell
Which number should you be contacted at in the evening ?	Home Work Cell
If there is an emergency during class, is there another person we contact if we are not able to reach you?	Please enter name and phone number
Does your child have any medical condition or take any medications that we should be aware of?	List conditions / medications here
All children learn differently. If your child has any specialized learning needs, please let us know. We will work with you to create the best dance experience for your child. You may make a note here or call the studio to consult with your teacher.	List your concerns here
To complete your enrollment, please mail your $75 payment for the first quarter tuition within three business days to: School of Dance Arts 2660 N. 72nd St. Omaha, NE 68134