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:

               
Dr. Name Phone
               
How did you
find us?

 

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.