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Registration Form 2017-2018

                                                                           Parentís Name___________________________

Studentís Name___________________________     Phone: Hm________________Wk________________

Address________________________________Age_____________

Cell Phone____________________________

City_________________________Zip______________email address_______________________

Ballet
() Creative Dance (3 yrs.)
() Creative Dance (4 & 5 yrs.)
() Basic Ballet
() Ballet I
() Ballet II
() Ballet III
() Ballet IV

Jazz
() Basic Jazz B
() Basic Jazz A
() Jazz I
() Jazz IIB
() Jazz IIA
() Jazz III
() Jazz IV
() Adult Jazz Fusion
Tap
() Basic Tap B (5-6 yrs)
() Basic Tap A (7 & up)
() Tap I
() Tap II
() Tap III
() Tap IV
() Beg. Teen/Adult Tap
() Adult Tap II
Hip Hop
() Hip Hop I
() Hip Hop II
() Hip Hop III
() Hip Hop IV

() Pointe Class

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DANCE! AND ALL THAT JAZZ!
125 N.E. Douglas St. ē Newport, OR 97365
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