Code____Jazz____Sis_____

         SECONDARY PRE-REGISTRATION

           (For enrolling more than 1 student)

Student’s Name_______________________Age(9/11)____DOB_____

Grade(9/11)___School_________________  Dismissal time______

Other family members being enrolled______________________

PHONE_______________Cell#_________________E Mail_____________________

Last year teacher___________________Routine in show__________________

I’m a new student here______ dance experience_____________

______PLEASE REGISTER HER FOR ADDITIONAL JAZZ CLASS(K&up w/dance2yrs or Summer jazz exp)Must Fill out extra JAZZ FORM

* This does not guarantee placement in an extra jazz class

Circle day you absolutely cannot attend M T W T F …..Reason_________________________________________________

If evening class required, earliest time you could be here_______