LEXINGTON
ACADEMY OF Dance
328
East Main Street
Lexington,
OH 44904
419-884-0684
web site: lexingtonaod.com
email: lexingtonaod@gmail.com
REGISTRATION
FORM
DATE_________________
STUDENT’S
NAME__________________________________________________
PARENT’S NAME____________________________________________________
PHONE #________________________
2ND PHONE______________________
e-mail____________________________
ADDRESS___________________________________________________________
CITY_____________________________________
ZIP___________
STUDENT’S
AGE______________
BIRTHDAY_______________
School Name________________________________________ Grade_________
CLASS SELECTION___________________________day
& time______________
List
prior dance training or performance experience___________________________
____________________________________________________________________
List any limitations that affect physical
activities_____________________________
____________________________________________________________________
List some of your child’s favorites (music, activities,
pets, TV shows, snacks etc)
____________________________________________________________________
____________________________________________________________________