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):
E-Mail Address
Address
How did you hear about us?
Anything we should know?
T-Shirt Size
Parent's Signature
Date