STEPS DANCE SCHOOL REGISTRATION FORM

Name:_______________________________________________ Birthday:_____________

Address:_______________________________________________ Zip:________________

Parents:____________________________________________ Phone:_________________

E-Mail:________________________________________ Work Phone: ________________

Referred By:______________________________ Medical: __________________________

Emergency Contact:__________________________________ Phone:_________________

Classes:_______________________ _____________________ _____________________

______________________ _____________________ _____________________

Return this form with that month’s tuition & registration fee to:

Steps Dance School 611 N. Third Garden City, KS 67846

For more information call: 620-271-0343

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