Student Name

*

Phone

*

Student or Parent Email

*

Date of Birth                 

    M     F

Address

*

City,State, Zip

*

Billing Address (if different)

Mother's Name

Father's Name

Parent's address (if different)

Mother

Father

Home Phone

Work Phone

Cell Phone

Place of Employment

E-mail Address

Home Phone

Work Phone

Cell Phone

Place of Employment

E-mail Address

Emergency contact (if different from above) *

Name: Phone

Class type:

Arts Camp (fill in details below) Jazz Ballet HipHop Musical Theatre Zumba Fitness Tap Bellydancing Philippine Martial Arts Pilates Rising Stars Dance Power

Kinderstudios will now be using Compete Services for ongoing tution payments. Please call or come by to pick up a payment authorization form. Please remember, you are NOT registered for your class until your payment is received! Special offer! Pay for one full year and get a free month!

comments or message to instructors:

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