fill out form below and return to the dance studio                             

Registration Fee of $15 due w/form

Dancer's Name__________________________________________________

Age ____________________ Grade______________

Phone # _________________ cell # _________________________

Address (include zip) _____________________________________________

email ________________________________________

Any allergies or special conditions that you wish to disclose?             

           

Parent/guardian Signature___________________________________date_______

Amy's Dance Dynamics will not be held responsible or liable for any injuries that may occur

Registration Form 2010/2011 Dance Season

     Class day and time :

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