Dance Loft Plus
Xenia, OH
Dance Loft Plus
1791 W Second St
Xenia, OH 45385
(937) 374-1404
info@xeniadanceloft.com
2010-11 Registration Form


Name of Student__________________         ___ Age ______Birth date______________

The classes I wish to take are……

Fall Class 1.   _____________________________________
 
Fall Class 2.  ______________________________________
 
Fall Class 3.  _____________________

Fall Class 4.

Fall Class 5.

Fall Class 6._________________
Notes (ie.day):

Home PhoneCell Phone

E-Mail Address

Address





Mom's OccupationPhone

Dad's OccupationPhone

How did you hear about us?

Anything we should know?
T-Shirt Size

Parent's Signature


Date
New Student
Continuing Student
August Weeks