South Loop School Hip 2013 (PDF)
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Author: Linda Butler
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South Loop School Hip-Hop Dance Class
Registration Form
Spring 2013
Parent's Name: __________________________________________________________
Child's Name: __________________________________________________________
Home Phone: ___________________________________________________________
Cell Phone: _____________________________________________________________
Address: ________________________________________________________________
Email Address: _________________________________________________________
Emergency Contact: _______________________________________________________
(other than parent)
Emergency Phone: _________________________________________________________
Please indicate if your child attends South Loop After school Program:
Please circle: YES or NO
Child's DOB:____/_____/____ Age/Grade Fall_________ Teacher______________
*Complete payment must accompany registration form
*Make Payment by check payable to: Linda Butler
*Please sign/return the attached Agreement when turning in registration form.
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Document ID: 0000069231.