Platinum Performing Arts: Miss Southern Utah Outstanding Teen Pageant

Online Registration Form

Student's Name:
Parent's Name:
Student's Age:
Date of Birth:
Phone Number:
Email Address:
Address:
Shirt Size:
What classes are you interested in? (check all that apply)	Mommy and Me 4-5 yr old 6-8 yr old 9-12 yr old 13-15 yr old 16 and up Dance Technique Private Vocal Lessons
How did you hear about us?	Flier Poster Newspaper article Newspaper ad Referral Other

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