Miss Patti’s School of Dance
85 Godwin Ave
Midland Park, NJ 07432
Phone (201)670-4422 Fax (201)670-5022
www.misspatti.com

Please prinit this form. Registration is on a first come - first served basis, and must be done in person on the first day of the appropriate enrollment period.
Mail in registrations are permissable and will be processed after the first day of in-person registration.

 

Dancer's Name _________________________________ Birth Date _________________

Address ________________________________________________________________

Phone Number __________________________

Parent's Name ___________________________________________________________

Email Address___________________________ Emergency Number _________________

Class Schedule (Please list 1st and 2nd choices for classes)

AGE
DAY
TIME
 
 
 
 
 
 
 

Comments (Use this space to share any information you feel we need to know about your child, i.e. any medical conditions or special needs.)