09/10 Class Schedule

Registration

For class consideration, rate schedule and registration please call (904) 399-5687 to speak
with Beth Marks in person. You may also fill out and submit the form below and
we will contact you as soon as possible. Please remember that class size is limited!

Parent's Name:				E-mail Address:
Student's Name (1):		Date of Birth (1):		Age (1):
(2):		Date of Birth (2):		Age (2):
(3):		Date of Birth (3):		Age (3):
Address:
City:
Zipcode:
Home Phone#:		Work Phone# (Mom):
Cell#:		Work Phone# (Dad):
Previous Dance Training?	No Yes	If Yes", how many years?:			1 2 3 4 5 6 7 8 9 10