Roseville School of Dance
<br />Im
<br />olf " I IIaHH P �� �: � 1"I'l7f . . .. .. .. .. .. it"
<br />"Ier i(,, .... .. . . .
<br />r ')fjj]
<br />is iI�,, r
<br />"I"i :wly" cz; I'll
<br />d, (1,
<br />0 :�'�[-Yyoj,t ix dance bagl an( I hea(."']
<br />s,
<br />a',[", [4,l, 0 t"'I 111 "'ll, v z z a, a m e Is, raft,
<br />'117 '11,
<br />-tl ��,H , 3 II ... . .. .. . .. .... 3 1 N 1, g,, I "'a c e "I,,), O,t ],nce C ac 1" e a f/1' a 1, IIIH
<br />C r a zi'I,'Ir 117,1 (1 1 ( . . ...... .
<br />i, r
<br />"I rig, a rij, d, (""'Ylt u se 1',),A'1N( I IN' ".� VIII VIII VIII
<br />"31''1"), xf%ir e v,
<br />E 'i�, sl3a ces Y uu
<br />11 1),11"1 E,0 'r", f"11
<br />Is at',, th e d o
<br />t a Ilk" ...... . g
<br />1", -:11 -,11 L IS tl`�,]`)(E��` Ili
<br />YL I 'III "") E`11 t-o e a(,
<br />it
<br />9 . .. .. .. .. ..
<br />3 ,
<br />P 1, a el call, 6 11, 92A 4, 77
<br />( In, a "��n, C
<br />"1 111) h I "I, C, o �f 1,
<br />x: (�:::111 �1 E�I'd �Iz', ''11, e
<br />p a rt C J 1) a In, tz;; , 1-i I dL.
<br />1111
<br />n� ]n, r I
<br />il Z1111. z"'. i"�1-1�1 d,,�ill, xlj% , I'l, b e 017-1 (led
<br />d < (-)iiA[7jll7 1`11 d i i Is e
<br />. .
<br />311" 1 1 r kji, l
<br />10 a n, 't",
<br />v e Is a
<br />t
<br />11
<br />J� Irj�, C T1 I
<br />lass tl,, o Ct o
<br />Ym i c a r��, e g i r st",
<br />, C l- ( I I , yal or b 'r J III o iLl, C1a r <: Is
<br />3
<br />cl t", a ct, a r k Is a ]n, d R, e c e at,, jill, o r��, ol i, c e
<br />W, I " ..� m 1�1111 ,re "
<br />0 A, 1, 1 (-"l (:::1, 11h ()01,
<br />h 11,�rijl ls'-�, ev
<br />..... . ..... .
<br />e 1, ( 11 e
<br />w� 1, 1, 1 J1, a I "I I 'N'Ji Gi� j,'t"
<br />W1 Ilk 11"', C " IS I 1 9 ,�l 61111 1
<br />1, A I,J 2
<br />W11''I"'N" IS a ti I I," C
<br />M a CI 2
<br />.. .. .. .. .. .. .. .. fll
<br />,1,) 3 01,11,111,118 0 0
<br />W1 I
<br />Y
<br />C, e nt,ll a r (."'o rr'i lil, 1 11,11, t"ly j"Y"I"D
<br />ra]
<br />III C ....... . .. I d 1 2,1
<br />K 91
<br />M N !E 15 'l, 13
<br />Z 0 Is N) i 11
<br />P11111111 111"I'v
<br />III :,I�l 2 1 ,,,1 42 4,
<br />C $1, 6
<br />------------------------------------------------------------------------------------------------------------------------------------------------------------ ,,, '.�11 a. ,,,, „.�,,,,,, � �i, i �1 �i' ��, ii e ��� NATNAI W
<br />1"?,oseville 1"I'ar"lli's and .,..ill k „ �,,,�µ V� V,. V V I,,, 'W
<br />T
<br />17 2 17
<br />I�� 2 171 `1 11' "D�:
<br />FV 11 E�1'1 11
<br />�hr� 113f,-�"r'SIAT� I'll ,),)i �friafl� at��� (��)s i �1 e IV! 1�,' IS 5113 -,- 1 79
<br />11, ly ''I (��) r� �,,
<br />Name:
<br />Address:
<br />Email:
<br />Kid's Night Out - Roseville School of Dance 5th Annual Program # 2901.424 $16-00
<br />Home Phone:
<br />City:
<br />Cell:
<br />State: Zip:
<br />Birth date:
<br />Does the participant have any special needs, or allergies our staff should be aware of? Yes No
<br />If yes, please explain:
<br />Form of Payment: Check Cash Visa Master Card American Express
<br />Credit Card Number:
<br />NI
<br />Cardholder's name:
<br />Parks & RecreaWn Deportn"wenj
<br />Cardholder's Signature:
<br />Exp:
<br />
|