STAR-LITE DANCE STUDIO REGISTRATION FORM
 
Student's Name: _______________________________________________ Age: _______ yrs
Birthdate: _________________    
Parent's Name: _______________________________________________    
Address: ________________________________________________________________________________________
Phone #: (______)_______________________ Cell#: (______)_____________________
  TYPE OF DANCE DAY OF CLASS TIME OF CLASS
1. ________________________________ _____________ _______________
2. ________________________________ _____________ _______________
3. ________________________________ _____________ _______________
4. ________________________________ _____________ _______________
5. ________________________________ _____________ _______________
PAYMENT OPTIONS (check one):
# Checks:____ Total Amount:____ Reg. Pd.:____    
VISA:____ Amount:____ Debit:____ Amount:____

Authorizing Signature: _______________________________________________________