Registration Form

Tippy Toes Dance Studio

Registration Form

The form below is for 2011-2012 Fall Registration. Please fill out all the blanks. We can't wait to see you soon!!!

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Studen't Full Name
Parent's Full Name(s)
Student's Birth Date
Age of Student
Grade
Adress
Email Address
Alt. Email Address
School Attending 2011-2012
Home Phone
Mom's Cell Phone
Mom's Work Phone
Dad's Cell Phone
Dad's Work Phone
Student's Cell Phone
Medical Information (ex, Allergies, Medications, Injuries)
Emergeny Contact (Name & Number)
Previous Dance Training (in years)
Where
Years at TTDS
How did you hear about TTDS?
Choose Day of Class
Choose Class

104 South Pine Street

PO Box 220

Princeton, NC 27569

(919) 936-0098

missleslie@tippytoesdancestudio.com