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/ JAZZ COMBO AGES 3-7 DATES: JULY 12, 13 & 14 TIME: 10:15 A.M.— 11:00 A.M. $40.00 POP STAR JAZZ CAMP AGES 5-8 DATES: JULY 12, 13 & 14 TIME: 11:00 A.M.— 11:45 A.M. $40.00 SELENA GOMEZ/TAYLOR SWIFT JAZZ CAMP AGES 8-12 DATES: JULY 12, 13 & 14 TIME: 11:45 A.M.— 12:00 P.M. $40.00 LYRICAL/BALLET CAMP AGES 8-12 DATES: JULY 12, 13 & 14 TIME: 12:30 P.M.— 1:30 P.M. $40.00 AMERICAN GIRL BALLET & JAZZ CAMP AGES 3-7 DATES: JULY 19, 20 & 21 TIME: 9:30 A.M.— 10:15 A.M. $40.00 TINKERBELL PRINCESS BALLET CAMP AGES 3-7 DATES: JULY 19, 20 & 21 TIME: 10:15 A.M.— 11:00 A.M. $40.00 POP STAR JAZZ CAMP AGES 5-8 DATES: JULY 19, 20 & 21 TIME: 11:00 A.M. — 11:45 A.M. $40.00 SELENA GOMEZ/TAYLOR SWIFT JAZZ CAMP AGES 8-12 DATES: JULY 19, 20 & 21 TIME: 11:45 A.M.— 12:30 P.M. $40.00
How Did You Hear About Our Studio?
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