Date:                                                                            

Returning Student:


First Name (Student):

Last Name (Student):

Mailing Addressing:

City:                                                                    State:                   Zip: 

Billing Address: 

City:                                                                   State:                    Zip: 

Contact/Parent Name: 

Email Address: 

Retype Email Address: 

Home Telephone Number (including area code): 

Work Telephone Number (including area code):

Cell Phone Number (including area code): 

Birth Date (Student):                                             School Attending: 

Previous Dance Experience (if any):



How did you hear about Rhythm Dance Studio? 
  
  If other or other search engine, please
      let us know how you found
       Rhythm Dance Studio:


If you have any Class Preference(s), please fill-out the following section:
    (You may refer to our current class schedule, but please keep in mind certain classes may not be available or may be closed, and the days/times are subject to
    change.  This information will be confirmed once registration is deemed received.)

     Class Title/Name(s)                                                                   Day(s)                               Time(s)

1).

2).

3).

4).

Method of Payment:  
 (Please remit payment within 1 week; although registration will not be considered complete until payment is received.)

If you prefer, you may supply us with the following information to help expedite the registration process:

Card Type:                                                   Card Holder Name:
 
Credit Card Number:                                                                                     Expiration Date:  

What color is the RED Rhythm Star?