710 Highway 139, Monroe LA 71203 • 318-345-1155
—— 2009/2010 REGISTRATION ——

Now accepting applications!

Fill out the online registration form below.
Your class day and time will be mailed to you after our Open House Registration.

PRINTABLE REGISTRATION FORM

Student name
School attending
Name of responsible party*
Student age
Date of birth
School grade

Complete Mailing Address

Address
City
State + Zip
Home telephone
(Mother's work phone)*
(Father's work phone)*
(Mother's cell phone)*
(Father's cell phone)*

*Necessary if student is under 21.

In which classes do you wish to enroll? (Click on any of the classes below for further information.)

A$40.00
 B$50.00 C$60.00 D$65.00
E$40.00 F$55.00 G$70.00 H$100.00
I need classes after work hours. **Name of day-care
Day-care will provide transportation.**

Amount Due

(Including $30.00 Registration Fee per Student)

Print out this form and mail with your check to:
MISSY CRAIN SCHOOL OF DANCE • 710 HWY 139 • MONROE LA 71203 • 345-1155