2013-2014 Membership Form

Parent Information:

Mother

Name:________________________________________________________________

Address_______________________________________________________________

City___________________________________________State________Zip_________

Email:_________________________________________________________________

Phone #(s):____________________________________________________________

Employer:______________________________Position:_________________________

Father

Name:________________________________________________________________

Address_______________________________________________________________

City___________________________________________State________Zip_________

Email:_________________________________________________________________

Phone #(s):____________________________________________________________

Employer:______________________________Position:_________________________

Student Information:

Name:________________________________________________________________

Age:____________________DOB:________________Grade:____________________

School:________________________________________________________________

LBS Class Level:________________________________________________________

Please complete and attach cash or $25 check made payable to PALS

(Parent Association Louisville Ballet School).

Money can be dropped in the PALS dropbox at the St. Matthews Studios.