Dance Lesson Form

Student's Name

First Name

Last Name

Parent's Name(s)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Dancing Level

F.U.S.T.A. Registration Number

Optional

Fees per Session

*Sessions run Fall or Spring *Price includes DSHA membership fee

Questions for Instructors