Enrollment

Student Type*

Student Name*

First Last

Age of Student*

Parent/Guardian Name*

First Last

Phone*

Parent/Guardian Email*

Student Email

If different than Parent/Guardian Email.

Address*

Street Address Address Line 2 City State ZIP Code

Student Photos*

ALL PHOTOS OF STUDENTS TAKEN THROUGHOUT THE SEASON MAY BE USED IN ADVERTISING OR ON OUR WEBSITE. IF YOU DO NOT WANT YOUR PHOTOS TO BE USED PLEASE INDICATE BELOW.

I will allow photos
I will not allow photos

Class Day*

Class Time*

Teacher*

Parent/Guardian Signature*

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Name

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step by step

Dance Academy

Step by Step Dance Academy

7645 Pershing Blvd, Unit #C, Kenosha, WI 53142

studio716@wi.rr.com

(262) 902-6323