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THE LAUREL SCHOOL OF DANCE online registration form.

* Indicates required field

Student's Name *

First

Last

Student's Birthday *

Student's Age *

Parents Name/Guardian *

First

Last

Home Phone Number *

Cell Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Emergency Contact *

Enter your Emergency Contact Here, i.e. Father, Grandmother, Grandfather, Uncle, Aunt

Emergency Contact's Phone Number *

Choose Your Dance Class Interests (You can select more than one) *

Twinkle Star (3 to 5 Years Old) Ballet (6-18 Years of Age) Tap (6-18 Years of Age) Jazz Funk (6-18 Years of Age) Enchanted Beginnings (18-36 months) Hippety Hop & Roll ( 4-6 Years of Age)

Session Interested In: *

Fall Summer All Winter

Class Time, Day its offered and Session you are interested in. *

You may choose more than one class

Dance Experience (if any) *

You may selected more than one class time.

How did you hear about us? *

Submit

THE LAUREL SCHOOL OF DANCE online registration form.

The Laurel School of Dance 22462 Henning Road Danville, IL 61834 217-443-8373