COSTUME DEPOSIT SLIP
Student’s Name:_________________________________________________
Parent’s Name_________________________________________________
Address:________________________________________________________City: _________________________________ Zip Code: _________________
Phone: (______)
________________________
Long: _______ Geer Park:_____ Southgate: ______
| Dance Subject | Lesson Day | Lesson Time | $55 per costume |
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TOTAL COSTUME DEPOSIT PAID: $____________ Costume Deposits are due 1st Lesson in February
Checks payable to: Sickle’s Dance Gallery
1431 Whittier Place, Dearborn, MI 48124
Phone: (313) 278-1035 Place this slip and payment (check or cash) in an envelope and hand to
your child’s teacher.
RECEIPT WILL BE MAILED TO YOU.
Office Confirmation:
Amount Received: $____________ Check #____________ Cash
_______
Dated: _______________________ Recorded by:____________________