Main Street Dance

Main Street Dance Location
Hammond, LA
Slidell, LA
General Information
Student's Name *
Birthday *		/  /
Age *
Grade Level
Father's Name
Mother's Name
Mailing Address
City
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Zip
Contact Information
Home phone		-  -
Work phone		-  -
Cell phone		-  -
Other phone		-  -
Email
Emergency Contact Ph. #1		-  -
Emergency Contact Ph. #2		-  -
Previous Dance Experience
Honors or Awards Received
Activities Involved in
Please list your child's favorite:
Color
Candy
Music Group
Are there any foods that your child is allergic to or does not like?
Is there a particular area you would like your child to improve on?
How did you hear about us?
Check the classes you are enrolling in
Baby Dolls
Angels
Lil Sweethearts
Princess
Showstoppers
All Stars
Superstars
Supermodels
Divas!
Hip Hop
Musical Theater
Summer Classes
Company Auditions
Just Tap
Other
Day and Time of class you are requesting.
Additional Information
Email address
To *		-- Registration
Subject *
Message *
Copy code to the box below (This helps prevent spam) *
* Please note that fees should be sent via regular mail or in person. Don't hesitate to call if you have any questions.