Kenmore Online Reg.

Please fill out and submit the form below to reserve a spot for your child. You will receive an email acknowledgment. This form is for the KENMORE studio only. Please use the Williamsville Online Registration form for the Williamsville location.

Please mail registration form of $10/ 1 student - $20/ 2 students - $25/ 3 or more students:

Jamie Kiefer

159 South Irwinwood Rd

Lancaster, NY, 14086

Visit our Online Payments Page to pay with Visa/MC/Discover

* Required fields
Name *
E-mail Address *
Parent's Names
Home Address
City & Zip
Phone # 1
Phone # 2
Date Of Birth
Age As Of September 2010
Emergency Contact Name & Phone Number
Any Allergies or Medical Conditions? If yes, please explain.
Classes Registering For:
	Creative Movement Ages 2-3 Saturday 9:30-10:15AM
	Preschool Combo Ages 3-4 Saturday 10:15-11:00AM
	Preschool Combo Ages 3-4 Thursday 4:45-5:30PM
	Kinder Combo Ages 5-6 Saturday 11:00AM-12:00PM
	Kinder Combo Ages 5-6 Thursday 5:30-6:30PM
	Jazz (7 & up, email or call for schedule information)
	Tap (7&up, call or email for schedule info)
	Ballet (6 & up, email or call for schedule info)
	Hip Hop (6&up, call or email for schedule info)
	Acrobatics (5 & up, call or email for schedule info)
	Lyrical (8 & up)(must take ballet)
	Musical Theater (Ages 10-14, call or email for schedule info)
How did you hear about us?
Please describe any previous dance lessons:
Any questions or comments?

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