2^ND STREET STUDIO 

WINTER session REGISTRATION FORM

**     JANUARY 3^RD – MARCH 10^TH **

Date:______________________

Name:_______________________________________

Address:_________________________________________________________________

City/State/Zip:__________________________________________________________

Phone Number:___________________________

Emergency Phone Number:_________________________________

Doctor:______________________________________

Write your initials in front of the workout plan you are paying for:

_____ $65 for unlimited classes
_____ $50 for Tuesday and Thursday only -- no substitution
_____ $30 for Saturday only -- on substitution

Paid by: Check#____________ Cash __________

(If registering by mail-please do not send cash.)

Please bring your workout shoes. No street shoes are allowed on workout floor. For safety’s sake, do not bring children to any workout.