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Please fill out form to become our previleged student member.

Student registration form
(1) Contact infomation
Prefix	First name		Last name
Street1
Street2
City/Town
State/Province
Postal Code
Phone
E-mail
(2) Tell us abour yourself
BirthMonth
age
(3) What dance are you interested in learning?
Hustle	Salsa	Tango		Waltz	Cha Cha
(4) Would you be interested in the private lesson?
Yes	No

Dance Patio™
1234 Bird st.
Saratoga, CA 95129
(408) 741-8734
Visit our web site Dance Patio, Inc