2012 Summer Dance Camp Online Registration/Enrollment

To enroll at the Little Rock School of Dance and ensure a spot for you or your child, complete this online form and then send your registration payment for $10.00 (check or money order only, no cash) to:

Little Rock School of Dance
8620 Cunningham Lake Road
Little Rock, AR 72205

2012 Summer Dance Camp Online Registration/Enrollment Form

Your Email (required)

Class Name (required)

Class Time (required)

Student Info

Student Name (required)

Age (required)

Date of Birth (required)

Years of Dance Experience (required)

Mother's Name

Father's Name

Home Address (required)

City (required)

State (required)

Zipcode (required)

Main Phone (required)

Alternate Phone (cell, work, etc)

Emergency Contact Info

Emergency Contact #1 Name

Phone Number

Relation to Student

Emergency Contact #2 Name

Phone Number

Relation to Student

Other Siblings in Dance

Sibling #1 Name

Age

Date of Birth

Years of Dance Experience

Sibling #2 Name

Age

Date of Birth

Years of Dance Experience

Sibling #3 Name

Age

Date of Birth

Years of Dance Experience

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