PARENTS' NAMES___________________________________________________________________

ADDRESS___________________________________________________________________________

HOME PHONE__________________EMERGENCY PHONE___________EMAIL_____________

PAST DANCE EXPERIENCE___________________________________________________________

WHAT CLASS ARE YOUR REGISTERING FOR? (IF YOUR CLASS IS CLOSED, WE WILL CONTACT YOU)

CLASS NAME________________________________CLASS DAY AND TIME________________

REGISTRATION FEES:  $10.00 FOR CURRENT STUDENTS; $15.00 FOR NEW STUDENTS

PLEASE PRINT FORM AND MAIL REGISTRATION FEES AND THE FIRST MONTH'S TUITION ($42.00) TO THE ADDRESS BELOW.

MAKE CHECKS PAYABLE TO DANCEXPRESS DANCE STUDIO.

313 IONA AVENUE
NARBERTH, PA 19072

PH: 610-668-4645
WWW.MYDANCEXPRESS.COM