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
	4:00 - 5:00 Ballet/Tap/Tumbling Preschool -
	5:30 - 6:30 K5-1st Combo Balle/Tap/Jazz - FULL
	6:00 - 6:30 Tiny Tots age 2 - FULL
	6:30 - 7:30 Preschool combo 3-4 - FULL
	6:30 - 8:00 Ballet/Tap/Jazz/Hiphop -
	7:30 - 8:30 Dance Team Technique -
	7:40 - 8:00 Hip Hop ages 6-8 -
Tuesday
	4:00 - 5:00 Preschool Combo 3-4 - FULL
	5:00 - 8:00 Jazz/Contemporary -
	6:00 - 7:15 Ballet/Tap/Jazz Combo ages 5-6 -
	7:00 - 8:00 Jazz and Hiphop -
Wednesday
	4:00 - 5:30 Jazz/Contemporary/Hiphop -
	5:30 - 6:45 Ballet/Tap/Jazz /Hiphop Combo age 6-8 - FULL
	5:30 - 6:30 PRESCHOOL COMBO3-4 -
	6:30 - 7:45 Jazz/Tap/Hiphop ages 9-11 -
Thursday
	3:30 - 4:00 Tiny Tots age 2 -
	4:00 - 5:30 ballet/tap/jazz/hiphop combo -
	5:30 - 6:30 Preschool Combo ages 3-4 -
	6:15 - 6:45 Tiny Tots age 2 -
	6:30 - 8:00 Jazz/Lyrical/Hiphop Combo -
	7:30 - 8:30 Jazz/Hiphop -
Friday
	4:00 - : Tumbling Ages 5-8 -

Parent/Guardian name: Date:

DANCE ARTS STUDIO
401 Hwy 11 North
Ellisville, Mississippi 39437