Silver Lakes Dance Studio
26540 Vista Road Suite c, Helendale, CA 92342 CA 818.747.3349
Student Information
Name of participants
Name
*
First Name
Last Name
Age
*
Gender
Male
Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
*
Email
*
example@example.com
Select the class you are registering for
Music and me
Yoga / Pilates
Tippy Toe Ballet
Ballet 1
Hip Hop 1
Ballet 2
Hip hop 2
Hip Hop Aerobics
Other
Relationship
*
Payment & Confirmation
Parent/guardian
First and last Name
Contact #
My Products
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ONE CLASS A WEEK 4 TIMES A MONTH
One class a week ballet hip-hop yoga Pilates
$
56.00
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10
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2 CLASSES A WEEK 8 classes a month
$
112.00
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9
10
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$
0.00
3 classes a week 9 classes a month
$
156.00
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$
0.00
ONE CLASS
$
20.00
Quantity
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Item subtotal:
$
0.00
GIFT Certificate
Give The gift of dance good for 8 30 minute classes
$
100.00
FREE TRIAL CLASS FIRST MONDAYS ONLY
Drop in on a free trial class every first Monday
$
Free
Parent/guardian Signature
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