Midwest Dance Explosion Home Page
Class Registration Form
Name: Birthday:
Class 1: Day 1:  Time 1:
Class 2: Day 2:  Time 2:
Class 3: Day 3:  Time 3:

Guardian: Home Phone:
Work Phone: Cell Phone:
Address:
City: State: Zip:
E-Mail:
Emergency Contact: Phone:
How did you hear about us? Friend     Newspaper
Web site Walk in   Other
If referred by a friend, include their name:
Comments,
Questions, or
Extra Classes

You may download this printable form to be filled out and turned in at the studio "Click" here. Adobe Reader is required to print the file. If you don't have it you can click the button below.