Jan’s School of Dance Summer Session 2011
June 13 – July 29

Fields Marked With "*" are Required

Student Name*

Student Birth Date*

Student Age*

Student Grade*

Student Address*

City*

Zip Code*

Classes Interested In (Check All That Apply)
 Ballet Hip Hop Jazz Jump & Turn Lyrical Partnering Pilates Tap Tumblebear Tumbling

Years Experience
12345678910+

Guardian Name*

Home Phone*

Work Phone

Mobile Phone

Other Phone

Email*