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.)

______________________________________

Please mail to:

FootWorks

3164 Golden Pond Dr.

Norman, Oklahoma 73072

or

 e-mail to:

Footworks5@aol.com