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Hanford 1716 N 11th Ave Ste B Hanford, CA 93230 (559) 587-1101 - Phone (559) 587-1120 - Fax

Lemoore 213 C St Lemoore, CA 93245 (559) 924-1101 - Phone (559) 587-1120 – Fax

Director: Katie A. Heugly

Director:

Katie A. Heugly

Student Information Form

2012 KINGS DANCE CENTER REGISTRATION Information- Fill out the following information and our staff will call and confirm class placement and amount due

Default Information

Student's Last Name: *

First Name: *

Mailing Address: *

City: *

Zip: *

Parents' Name: *

Home Phone: *

Cell Phone (mom):

Work Phone (mom):

Cell Phone (dad):

Work Phone (dad):

Birth Date: *

Age: *

Gender: *

Email:

New Student:

Yes

No

If Yes, how did you hear about us?

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