First Name:* Last:

Parents name:* Birthdate: Age:

Home Phone # Cell Phone #:

Do you receive text messaging? Yes No

Address:

City: State: Postal Code:

Email:*

* = Required items

Please select the class(es) you are enrolling in:

Monday
	2:30 - 3:30 Preschool combo age3-4 -
	4:00 - 4:45 Ballet I -
	4:00 - 5:15 ballet/tap/jazz -
	5:15 - 6:15 Ballet IV -
	6:00 - 6:30 Tiny tots - FULL
	6:15 - 7:30 Ballet/Tap/Jazz age 5-6 -
	6:30 - 7:30 Preschool combo 3-4 -
	7:30 - 8:30 Dance Team Technique - FULL
Tuesday
	4:00 - 5:00 Preschool Combo 3-4 -
	5:00 - 6:00 Preschool Combo 3-4 - FULL
	6:00 - 7:00 Preschool Combo 3-4 -
	7:00 - 8:30 Jazz/ Hiphop age 11-15 -
Wednesday
	3:30 - 4:00 Tiny Tots -
	4:00 - 5:30 Combo staff placement only - FULL
	5:15 - 6:45 Combo age 5-8 -
	5:30 - 6:30 PRESCHOOL COMBO3-4 -
Thursday
	4:00 - 5:00 Combo ballet/tap/jazz ages 5-6 -
	4:00 - 5:00 Ballet II -
	6:00 - 7:15 Ballet III -
	6:00 - 8:00 Jazz/Tap/Hiphop Combo -
Friday
	4:00 - 5:00 Preschool Combo -

Parent/Guardian name: Date:

DANCE ARTS STUDIO
401 Hwy 11 North
Ellisville, Mississippi 39437