Contact and Contribution Information

Contact Information

To register for classes or to receive more information,

please e-mail or contact us by phone. You may also
fill out the form at the bottom of this page for information or as a pre-registration form.

Kinetic Revelation Academy of Dance

Fort Wayne, Indiana
Mailing address: 3817 South Drive, Fort Wayne, IN 46815.
Classes held at 10006 Auburn Park Drive, Fort Wayne, IN 46825

260-446-7279

studio@kineticrevelation.org

Classes are held in our new
Dupont area location, 10006 Auburn Park Drive inside Steppin' Up Physical Therapy and Fitness, next to Sylvan near Debrands.

Please download our Policies and Registration Forms below page, fill them out, and send them, along with your registration fee, to:

Kinetic Revelation, 3817 South Drive, Fort Wayne, IN, 46815.

Registration Form

KR Policies 2010

Medical and Authorization Release Form

Contact Information:

Contact Name:

Home Phone:

Cell Phone:

Email:

Mailing Address
(please include zip)

Please Contact Me Via

Student's Information

First Name

Last Name:

Age

years

Previous Dance Experience? Yes No

Style	Years
Tap
Jazz
Ballet
Pointe
Other

Request more information on::

Mommy & Me Ballet Tap Pointe Jazz HipHop Worship

Other Notes or Information

Kinetic Revelation * Fort Wayne, Indiana

* 260-446-7279 * e-mail: kineticrevelation77@gmail.com