Addis Studios For The

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Addis Studios

Glenshaw Public Library, Butler Plank Road

Glenshaw, PA 15116

(412) 487-6760

2009-2010 REGISTRATION

Student Name	__________________	Age	_________	Birth date	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________

Student Name	__________________	Age	_________	Birth date	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________

Student Name	__________________	Age	_________	Birth date	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________
Class	__________________	Day	_________	Time	________________

			Total number of classes per family	______________
			Total September fees due:	$_____________
			Registration Fee:	$_____________
			TOTAL AMOUNT DUE WITH REGISTRATION:	$_____________

All fees must be remitted with registration form. All classes are filled on a "first come" basis. Please make checks payable to Addis Studios.

Please register my child/children for the above classes. I understand all appropriate participation fees and/or dancewear/shoes must be purchased separately if required.

Signature of Parent_____________________________________ Date______________

Street Address____________________________________________________________

City_____________________________________ Zip Code_______________________

Home Phone______________________________ Work Phone_____________________

Paid by: ( ) Cash ( ) Check #_________