LeRoux School of Dance

Making a Positive Difference in the Lives of Children!
Celebrating More Than 65 Years of Excellence in Dance!

Movie Night - Feb 11th 5:30 - 10:30 - Sign Up Begins 2/4

Valentine Candy & Lollipop Sale - Feb. 8 - 14th

Registration Form

This is NOT a guarantee, it is only a request for a class.
NO class is confirmed until we check for availability.
This information will NOT be shared or distributed!

Click here if you prefer a printable registration form.

Use Studio Schedule Information to fill-in this form.

Parent's First Name*:
Parent's Last Name*:
E-Mail Address*:	In the form: you@isp.com
Street Address*:
City*:
State*:	Two Character
Zip*:	In the form: 19123
Home Phone*:	In the Form: (610) 555-1234
Cell Phone*:	In the Form: (610) 555-1234
WorkNumber & Extention:
Child #1 Name*:
Child #1 Date of Birth*:	In the form 01/01/01
Class Requested*:
Day of Class*:
Time of Class*:
Child #2 Name:
Date of Birth:	In the form 01/01/01
Class Requested:
Day of Class:
Time of Class:
Child #3 Name:
Date of Birth:	In the form 01/01/01
Class Requested:
Day of Class:
Time of Class:

*- Required Information