
FOOTWORKS STUDIOS
ENROLLMENT FORM
e-mail to footworks5@aol.com
Student's Name_________________________
Student's Age_______ DOB________________
Parents/Legal Guardian__________________________________
_________________________________________
Address___________________________________
City__________________Zip_________________
Home phone_________________________________
Mother's cell phone_______________________
Father's cell phone_______________________
Are able to receive text messages?_________Referred by__________
E-mail address________________________________
Class/Classes enrolling into:
1.___________________________________
2.___________________________________
3.___________________________________
4.___________________________________
5.___________________________________
6.___________________________________
Please list any medical conditions or information we need to know about your child. (asthma, ADD, recent divorce, ect.)
______________________________________