Ablaze in Worship Dance Ministries Registration Form
Location: 210 Christian Gospel Assembly, Durban Street
Contact Number: 765-8662
Facebook: Ablaze in Worship Dance Ministries
Email: ablazeinworshipdanceministries@gmail.com 

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Age: *
D.O.B: *
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Address: *
Contact Number: *
Name of the church you attend: *
Are you baptized? (water baptized) *
If student is a minor please fill out the following information 
Parent/Guardian’s Name:
Relation:
Address:

Does your child have any allergies or medical conditions we should know of? If so, please explain:

Please list emergency contacts in order of priority. E.g Cousin -600-****, Sister- 601-****,etc) 

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Date: *
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Signature: *
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