Fall Registration Form

    The following student(s) want to register for the following fall classes:

    Student’s Name(s) and Grade(s) (required):

    Student's Birth Date (mm/dd/yy required):

    Parents’ Name(s) (required):

    Mailing Address:

    Email Address (required)

    Home Telephone:

    Cell Phone:

    Emergency Phone/Contact:

    *Please register by submitting this completed registration form and submitting your payment at your earliest convenience to THE DANCE STUDIO, 107 North Marion Street, Kirksville, MO 63501). Class positions are limited in numbers and will be filled on a first come, first served basis.