Dance Class Registration Form

Complete the email form below and submit it or print and mail the Student Registration Form.

Student Name	Birthdate (if under 18)	Age

Home Address	City	Zip

Home Phone	Cell Phone

Mother/Guardian's Name	Work Phone	Cell Phone

Father/Guardian's Name	Work Phone	Cell Phone

Emergency Contact Name	Number(s)


Classes	Day	Time

Judah Performing Arts Center 4237 Eastland Square Drive Columbus, Ohio 43232 614-595-3709