2010-2011 MDP DANCE ADMISSION FORM
Dates: 10/1, 12/3, 1/21, 5/20
Time: 7:00 p.m.
The cost is $6.00 per person
All information must be completed by parent before student will be admitted to dance!
Student's Name: ____________________________ Grade: ________
(check one)
[ ] MDP Student
[
] MDP Parishioner
[ ] MDP CYO
[ ] Guest: Of whom: __________________________
School: __________________________
Home Phone: ________________________
Other number where parent can be reached during dance: _____________________
Parent's Name: ______________________________
Signature: ______________________________ Date: ___________