Miss Libby's School of Dance

Student's Name:		Date of Birth:
Parent's Name:		Address:
City:		State:	Zip:
Email Address:		Home Phone Number:
Work Phone Number:
Number of years of dance or gymnastics:
Preschool Combination - Ages 2-5:
	Tap and Ballet
Introduction to Dance - Ages 6-9:
	For Beginners Tap, Jazz and Ballet
Combination Classes - Ages 6-9:
	Tap and Jazz Tap and Ballet Jazz and Ballet
Full Hour Classes:
	Ballet Tap Jazz Pointe Modern
Adult Classes:
	Adult Jazz Adult Tap Adult Ballet
Gymnastics:
	Beginner Intermediate Advanced