Registration Form

Pre-Registration Form
Fall 2008

Complete this form online so you don't need to fill out the form at the studio.

Debra Franco Preparatory School of Dance
3420 Wisconsin Ave
Vicksburg, MS 39180
601-638-7282			Registration Date:

Billing Name

Address

City			State	Zip/Postal

Hm. Ph.			Wk. Ph.

E-Mail			Cell Ph.

Parent 1			Hm. Ph.

Employer			Wk. Ph.

E-Mail			Cell Ph.

Parent 2			Hm. Ph.

Employer			Wk. Ph.

E-Mail			Cell Ph.

Emergency Contacts			Phone

			Phone

Student

Address

City			State	Zip/Postal

Birthdate		School
		Grade

E-Mail			Cell Ph.

Interests	Ballet Tap Jazz Acrobatics Pre-Toe Pointe Modern

Medical Info:	injuries or allergies that may affect dance
	injuries or allergies that may affect dance

Dr. Name			Phone

How did you find us?	newspaper, radio, TV, word of mouth?

The Debra Franco Preparatory School of Dance is not responsible for belongings left in the studio. We cannot be held liable for any injury to students during any of our classes or on the school premises.