Fall Registration Form

    The following student(s) want to register for the following fall classes:

    Student’s Name(s) and Grade(s) in school:

    Student's Birthdate (mm/dd/yy):

    Parents’ Name(s):

    Mailing Address:

    Email Address

    Home Telephone:

    Cell Phone:

    Emergency Phone/Contact:

    *Please register by submitting your payment at your earliest convenience online here at our web site by clicking “Pay Online” or by mailing your payment to The Dance Studio, 107 North Marion Street, Kirksville, MO 63501). Class positions are limited in numbers and will be filled on a first come, first served basis.