Amy Lynns Dance Studio

ONLINE REGISTRATION FORM
Welcome To Our 2010 Summer Dance Camp
Students Last Name
First & Middle Name
Date of Birth
Age
Grade
Address Street 1
Address Street 2
City
State
Zip Code
Parents First & Last Name
Home Phone
Work Phone
Cell Phone
Email Address
Emergency Contact Name & Number
List Previous Dance Experience & Number Of Years	Example: Tap 2 years
Classes You Would Like To Register For (Can Check More Than One)	CINDERELLA PRINCESS BALLET CAMP/ DANCE DANCE DANCE CAMP AGES 3-7 DATES: JULY 12, 13 & 14 TIME: 10:15 A.M.—11:00 A.M. $40.00 TINKERBELL PRINCESS BALLET CAMP - FREE TINKERBELL T-SHIRT AGES 3-7 DATES: JULY 20, 21 & 22 TIME: 10:15 A.M.—11:00A.M. $40.00 TAYLOR SWIFT/ SELENA GOMEZ/ STARSTRUCK JAZZ CAMP FREE JUSTICE T-SHIRT AGES 6-8 DATES: JULY 20, 21 & 22 TIME: 11:00 A.M.—12:00 $40.00 JUSTIN BIEBER HIP HOP/ JAZZ CAMP FREE JUSTIN BIEBER T-SHIRT AGES 9-13 DATES: JULY 20, 21 & 22 TIME: 12:00 —1:00P.M. $40.00 LYRICAL/BALLET CAMP FREE JUSTICE T-SHIRT AGES 8-12 DATES: JULY 20, 21 & 22 TIME: 1:00P.M. —2:00P.M. $40.00
How Did You Hear About Our Studio?
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