ALL STAR DANCE ACADEMY INC
440 SOUTHLAKE BOULEVARD SUITE 23C
RICHMOND, VA 23236
PHONE/FAX (804) 379-9393
michelleallstardance@gmail.com
Homeschool Registration 2011-2012
Please Fill Out Completely.
Dancers' Name__________________________________________________
Nickname (if any)_______________________________________________
Age (as of September)___________________________________________
Address___________________City__________________Zip_____________
Subdivision/Area_____________________Upcoming School Grade________
Previous Dance Experience(if any)__________________________________
Types of Dance Studied/Years_____________________________________
Any Health Problems__________________Physcial Limitations___________
Medications/Allergies_____________________________________________
Guardian's Name____________________________Phone/Cell____________
Email__________________________________________________________
Emergency Contact_________________________Phone________________
Schedule: Please Circle Class Choice:
Tuesday 12:30-1:30 3-5 years (Tap/Ballet)
Tuesday 1:30-2:30 6-8 years (Tap/Ballet)
Tuesday 2:30-3:30 8 and up (Tap/Ballet)
Wednesday 12:30-1:30 3-5 years (Tap/Ballet)
Wednesday 1:30-2:30 6-8 years (Tap/Ballet)
Wednesday 2:30-3:30 8 and up (Tap/Ballet)
To register early, you may print this form and mail in completed form. Registration Fee is $5. Your spot will not be held unless registration fee is received. Email us for monthly fees.