Parent Name
Last Name
Street Address
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
City
Zip Code
Phone Hm
Phone Cell
E-mail Address
Child #1
Birthday
Child #2
Birthday
Child #3
Birthday
Please Select First Choice Class Location and Time.
Ashland- Oak St. Dance Studio
1287 Oak St. Ashland OR 97520
Tuesday 10:00 - 10:45
Tuesday 11:00 - 11:45
Tuesday 5:30 - 6:15
Friday 10:00 - 10:45
Friday 11:00 - 11:45
Medford- Cyl-ebrity Dance Studio
301 Ivy St. Medford Oregon 97501
Monday 10:00 - 10:45
Monday 11:00 - 11:45
Friday 5:30 - 6:15
Saturday 10:00 - 10:45
Saturday 11:00 - 11:45
Jacksonville- Library Community Room
340 West "C" St Jacksonville OR 97530
Thursday 10:00 to 10:45
Thursday 11:00 to 11:45
Second Choice Class Location and Time.
Ashland- Oak St. Dance Studio
Tuesday 10:00 - 10:45
Tuesday 11:00 - 11:45
Tuesday 5:30 - 6:15
Friday 10:00 - 10:45
Friday 11:00 - 11:45
Medford- Cyl-ebrity Dance Studio
Monday 10:00 - 10:45
Monday 11:00 - 11:45
Friday 5:30 - 6:15
Saturday 10:00 - 10:45
Saturday 11:00- 11:45
Jacksonville- Library Community Room
Thursday 10:00 to 10:45
Thursday 11:00 to 11:45
First Child ($150)
Additional Siblings ($80)
Our orders are processed by PayPal. Once your form has been submitted you will be
forwarded to PayPal where you will then enter in your payment information.
Indicates Response Required