REGISTRATION FORM

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   Pleasant Valley Cloggers Featuring the Smashin’ Toe Kids Team
   Instructors: Pam Portz………612-991-3270       Ruby Martinson……..651-210-2029
     Location: Pleasant Valley Clogger's studio Lindstrom, MN
     Email: smashingtoe@yahoo.com

REGISTRATION FORM – Winter Session 2-7-12 to 4-3-12 Please register by 2-1-12

   Dancers Name:                                                 Age:         (if under 18)     Birthday:

   Parents/Legal Guardians: ( if under 18 )

   Address:

   City:                                                                         State:                    Zip:

   Home Phone #:                                          Work/Parents Work #:

   Email:                                                        Emergency Contact Phone #:

Beginner classes are held on Tuesday Evenings - click HERE for a map & directions.

Ages 6-Adult are also from 5:00-5:30

FEES FOR 9 WEEK                                    BEGINNER CLASSES & PAYMENT OPTIONS:
BEGINNER SESSION                             ( Check One)
1 Person………….....................$ 40.00   Beginner  Ages 3 - 6    NA                  Check Enclosed for $                  or
2 in Family…………….............$ 70.00   Beginner Ages 6 - Adult             I will be attending the 1^st Class FREE
3 or more in Family...................$ 90.00

    Please make checks out to : The Pleasant Valley Cloggers

      ** Beginner session fees are based on an 8 week period. 1^st week is a FREE trial class!
        *After the 8 week beginner session, fees are paid at the beginning of every month.
Monthly dues are $20 for 1 person, $35 for 2 people, & $45 for 3 or more people.
All profits made go into our group for equipment, materials, customs, etc...

            ***Please mail payment and Registration form to: Pam Portz, 31080 Foley Ave, Stacy, MN 55079