(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:__________