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Dance Troop 4th and 5th Grade Girls What: Four Musick Studios dance lessons and fun, aMuse Journey theater activities. Celebrate with a dance performance for friends and family! When: September 10, 17, 24, October 1, 8, 15. Each Saturday, 9:30-11:00 a.m. Where: 140 Salem Drive Owensboro, KY 42303 Cost: $75.00 per girl, includes annual Girl Scout membership, dance lessons, and Journey book

Postmark Deadline to Register: August 30th Mail to GSK 140 Salem Drive Owensboro, KY 42303

Parent Name:

Girl Name:


Mailing Address: Day Phone Number:



Cell Phone Number:

School Name: Girls must be in the 4th or 5th grade for the 2011-2012 school year. Have you been a Girl Scout before? ____No _____Yes, if yes, what year(s)________ Number of girls registering x $75.00= ______ TOTAL _________ In an effort to ensure that we are serving all girls, we encourage you to provide the following information on racial background and ethnicity for program participants: ____American Indian or Alaskan Native ____Asian ____Black or African American ____ Hawaiin or Pacific Islander ____ White ____ Hispanic or Latina ____Other

For Office Use only: Date: ___________ Receipt #: _________

Dance Troop