“DWD” 2008-2009 Studio Enrollment Form

Please complete and return with pre-registration payment.

Student’s Name: _______________________________________________  

Class Code:___________________________________________________

Age as of 9/08:_____________________      D.O.B:________________________   

Grade in 9/08:_____________________________

Address:____________________________________________________  Town/City:___________________________ Zip:_____________________       

Home Phone:____________________________ Work Phone:______________________________ 
Cell Phone:_______________________

E-Mail Address:_____________________________________________________________________

Allergies:__________________________________________________________________________

May we photograph your child? (Circle one)      yes           no 

Parent Signature:____________________________________________________________________

Enclosed is my Tuition Payment for Session #1, Fall 2008…..

Please check:

________Cash

________Check #_____Payable to:  “Dancing with Denise.”   

TOTAL ENCLOSED: $______________  

www.dancingwithdenise.com

2256 Hudson Ave.  Rochester 14617

(585) 266-5860

“Having Fun is Our Philosophy!”