To Reserve your place Print this page and fax it to 214.515.0195
This also will help you to enroll you or your child faster.
Once we receive this form someone will be contacting you.

UDA INITIAL REGISTRATION FORM  (Space reservation for Classes)
										M	F
Student Name					Date of Birth                                                             Age					Sex
					Parent’s/Guardian’s Name(s)
(    )		(    )			(    )				(    )
Cell Phone		Work/ Home Phone			Cell Phone				Work Phone
Address					Address
Email:					Email:
					Emergency contact:   Name:__________________________________________________   Phone__________________________________________________
CLASSES REGISTERING FOR
Class:					Dates/ Times:
Credit Card #:__________________________________________________________________exp/Date       ____________                    Billing Zip Code  :
TUITION: $
ENROLL FEE: Kids:    $35
Adults $20
Student, or Parent’s/Guardian’s Signature							Date
Witness Signature							Date

Please contact our office for further information
 214.515.0195
unitedanceacademy@gmail.com