4419 NE Sandy Blvd
Portland, OR 97213
503-249-0534
SUMMER DANCE REGISTRATION FORM

MAIL OR DROP-OFF AT THE STUDIO


Student’s Name(s): ______________________________________________________

Age (s): ___________,  _____________, ____________

Parent/Guardian: ________________________________________________________

Address: ______________________________________________________________

Daytime Phone: _________________________________________________________

Home Phone (if Different): _________________________________________________

Class: ____________________ Day: __________ Time: _______ Cost: _____________

Class: ____________________ Day: __________ Time: _______ Cost: _____________

Class: ____________________ Day: __________ Time: _______ Cost: _____________

                                                          Total Enclosed: ______________


Please make check payable to: Hollywood Dance