Jane Whitt's Dance Studio
Student Name ________________________________________________________
City _____________________ Zip ________ Phone ____________________
Birthdate ___/___/___ Grade-Fall 2012 _______ School _________________
Parent/Guardian Name __________________________________________________
Best Phone _____________________ Email ____________________________
A non-refundable $20.00 fee is due at time of enrollment. Once this form is received at the studio, you will be given the Enrollment Contract for your child which contains specific information regarding class times and fees.