Where every child becomes a part of our dance family!

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Print page and send with $45.00 registration fee to:  Lynette's Dance Studio
                                                                            3076 - 38 Avenue
                                                                            Columbus  NE  68601
            
 
 
Student's Name  ____________________________________________________________
 
Birthdate  _________________________________________
 
Age  ____________________
 
School  ___________________________________________
 
Grade  ___________________ (fall of 2010)
 
Parent(s) Name  ___________________________________________________________
 
_________________________________________________________________________
 
Address  _________________________________________________________________
 
Phone Number   ___________________________________________________________
 
Cell Phone Number  ________________________________________________________
 
E-mail  Address  ___________________________________________________________
 
Dancer's E-mail Address _____________________________________________________
 
Fill in E-mail address ONLY if you check your e-mail.