Online Registration/Enrollment

To enroll at the Little Rock School of Dance and ensure a spot for you or your child, complete this online form and then send your payment for $10.00 (check or money order only, no cash) to:
Little Rock School of Dance
8620 Cunningham Lake Road
Little Rock, AR 72205

2011 Summer Camp Online Registration/Enrollment Form

Class Name:

Class Time:

Student Information

Student Name:

Age:

Date of Birth:

Years of Dance Experience:

Mother's Name:

Father's Name:

House Address:

City:

State:

Zipcode:

Home Phone Number:

Alternate Phone Number (Cell, Work, etc):

E-mail Address:


Emergency Contact Info


Emergency Contact #1 Name:

Phone Number:

Relation to Student:

Emergency Contact #2 Name:

Phone Number:

Relation to Student:


Other Siblings in Dance

Sibling #1 Name:

Age:

Date of Birth:

Years of Dance Experience:


Sibling #2 Name:

Age:

Date of Birth:

Years of Dance Experience:


Sibling #3 Name:

Age:

Date of Birth:

Years of Dance Experience:


Comments: