2009-2010 ONLINE PRE-REGISTRATION FORM

(All students must complete the actual register form to be enrolled into studio classes.)

Student Name (First & Last)

Parent/Guardian Name (First & Last)

Email Address

Mailing Address (Street, Apartment)

City, State, & Zip Code

Primary Phone Number (incl. Area Code)

Relationship

Primary Division - *Full or 1/2 Year

Ballet, Tap, and Pre-Tumbling/Acrobatics

Secondary Division -

Ballet and Tap

Junior/Senior Division -

Ballet/Pointe,Tap, Jazz, and Modern

Boys/Young Men's Division -

Tap and Jazz

Adult Division

8-Week Course Dance Class

Winter 2010 - January 5th - March 2nd

Age

Division / Class Pre-Registration Interest:

(Select all that may apply; final enrollment is at the discretion of the instruction.)

Birthdate

Technique Classes

Basic Jazz

Tumbling / Acrobatics

Baton Twirling

Speciality Classes

Beginner

Intermediate

Advance

Beginner

Intermediate / Advance

Adult Basic -

Tap and Jazzercise

Adult Dance -

Ballet / Lyrical, Tap, and Jazz

Hip-Hop

1916 Central Avenue (2nd Floor), Kansas City, KS 66102 ~ Office/Message - (913) 281-5193

Web Address - www.jnealdance.com ~ Email Address - keydancer@jnealdance.com

June Neal Dance Studio

"The Spirit of DANCE"

June Neal Dance Studio, 2009 Copyright