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Kids Registration Form 少儿班注册表 2025-2026
Silk Road Dance Inc.
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Email *
Student Name 学生姓名 *
Nick Name 昵称/小名
Student's Age  学生年龄 *
Please fill out the age when July 1st. 请填写 7月1时的年龄。
Student's Birthday 学生生日 *
MM
/
DD
/
YYYY
Parent's Name 家长姓名 *
Parent/Guardian's cell phone number 家长联系电话 *
Home Address 家庭地址 *
Appt, Street # and name, City, Province， Postal code 公寓号，门牌号路名，城市，省，邮编
Emergency Contact Information 紧急联系人姓名/电话 *
Allergies/Medical Concerns 需详细过敏信息以及服药情况并通知到上课老师 *
Please fill N/A if not applicable 若没有相关情况，请填写N/A
School Location选择校址 *
Class Type 课程类型 *
Required
Please tell us which class and which time of the week you registering for ?  请详细填写报名的课程时间及种类
 *
Current Student, New Student OR Students Return in 3 years 目前是否为在校学生/新生/ 或者3年内返校生。
 *
Required
Parent Authorization & Consent 授权与免责声明 *
Read the above Parent Authorization & Consent， and please check the box to agree. 阅读授权与免责声明并勾选对话框以同意。
Captionless Image
Required
Method of Payment 付款方式 *
*Refund Policy: Please Check ALL Information to confirm that you have read it.
*退款政策(请勾选全部信息以证明您已阅读)
 *
Please check off ALL boxes to agree. 请务必勾选所有选项
Required
Registration Date 注册日期 *
MM
/
DD
/
YYYY
Parent Signature 学生/学生家长签字（18 years old under）
Please confirm the above information and print your full name to sign,请家长确认以上信息并签字。
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