Registration Form

(NOTE:  New enrollees must fill in completely.  Previously enrolled students fill in name, parent/guardian signature, change of address and/or phone number).

I have read and understand all of the SCHOOL REGULATIONS:, and wish to enroll for classes at the

Gary Geis School of Dance. (Note: enrollment fee should accompany registration)

Ballet_____,  Tap_____,  Jazz_____,  Creative Movement_____ (check classes)

 STUDENT’S NAME: __________________________ AGE_____ Birthdate_________

Previous Training:  Ballet________  Tap_________ Jazz________ (list years)

HOME ADDRESS: __________________________________ PHONE______________

                       ____________________________________________________________

MOTHER  _________________________Employer______________ PHONE________

OR FATHER:

GUARDIAN:________________________Employer______________PHONE________

Signature of Parent/Guardian_________________________________ Date:__________