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Student Registration Form For 2025-2026 Season                      
Must be completed by parent or legal guardian 
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Email *
Student's First Name  *
Student's Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade Level *
Home Address  (#, Street Address, Apt #, City, State, Zip) *
Parent 1 / Guardian First & Last Name

 *
Parent 1/ Guardian Mobile Number *
Parent 2 /Guardian First & Last Name *
Parent 2 / Guardian Mobile Number *
Parent 2 / Guardian Email Address

 *
Authorized Pick Up Names/Numbers (List anyone other than parents/guardian authorized to pick up your student)   
Emergency Contact Name & Mobile Phone   (Must be someone other than parent/legal guardian).   *
Physician's Name & Number *
Please list any known physical health, emotional/mental health-related considerations and sensitivies (including allergies, medications). *
At Which Studio Location(s) Will Your Child Take Class?

 *
Describe your child's dance training (if any) *
Class 1 - Include Class Day, Time & Description
(example: Tuesday, 6:05pm, Modern/Contemporary III) 
 *
Class 2 - Include Class Day, Time &  Description
Class 3 -  Include Day, Time & Class Description
Student Size  *
Check ONLY IF you would like to purchase Dance Works Apparrel, we have the following in stock (or you can visit our boutique directly at danceworks.us/boutique)
Did someome refer you?  (Yes/No) If so please include name so we may thank them.  *
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