ALL CLASSES REQUIRE A $25.00 REGISTRATION FEE. EARLY REGISTRATION IS RECOMMENDED, ESPECIALLY FOR THE YOUNGER CLASSES. THEY FILL UP QUICKLY AND SPACE IS LIMITED.

REGISTRATION FORM

NAME_____________________________________________ AGE________DATE OF

BIRTH___________________

HOME PHONE#___________________

ADDRESS__________________________________________________________________

CITY________________________________ZIP__________________________

SCHOOL_______________________________________GRADE______________________

PREVIOUS EXERIENCE______________________________________________________

MOTHER’S NAME_____________________________________

EMPLOYMENT_______________________________

WORK PHONE________________________________

CELL PHONE_________________________________

EMAIL ADDRESS______________________________

FATHER’S NAME_______________________________

EMPLOYMENT________________________________

WORK PHONE_________________________________

CELL PHONE__________________________________

EMAIL ADDRESS_______________________________

CLASS DAY AND TIME I PREFER_______________________________

$25 REGISTRATION FEE INCLOSED___________________

TODAY’S DATE_____________________________

Please return the following form to register and include your $25.00 registration fee. Mail to Kerry’s School of Dance, 16 Country Meadow Way, Cartersville, GA 30121 This is our mailing address. Physical address is 611 N Tenn. St, Cartersville, GA. 770-386-2125

EMAIL: KERRYDAN@AOL.COM WEB SITE KERRYSDANCE.COM