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Phone Number D.O.B. Age
Student’s Name
Parent’s Name
Address
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City State Zip
Emergency Number (Cell or Pager)
Email Address
CLASS # DAY/TIME CLASS TITLE
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 Tuition Rates

Number of hours danced a week ............
Monthly Tuition Fee .............................
Registration Fee ................................. $10.00
Total Amount Enclosed ........................ $

Please send your fees to:
St. Peters Academy of Dance, Inc.
93 Vantage Drive
St. Peters, Mo. 63376