San Juan Dance | 2020.2021 Enrollment App
140 3rd St. & 151 2nd St. Los Altos, CA 94022
Email address *
(1) Student Name *
(1) Student DOB *
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(1) Student Age as of 9.30.2020 *
(1) Student Class Choices
(2) Student Name
(2) Student DOB
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YYYY
(2) Student Age as of 9.30.2020
(2) Student Class Choices
(3) Student Name
(3) Student DOB
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DD
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YYYY
(3) Student Age as of 9.30.2020
(3) Student Class Choices
(4) Student Name
(4) Student DOB
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DD
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YYYY
(4) Student Age as of 9.30.2020
(4) Student Class Choices
Address (including City & Zip Code):
Cell Phone # (including Area Code):
Add'l Phone #:
Emergency Contact + Phone #:
Insurance Carrier Name:
Insurance Carrier Policy #:
Please review; click to agree. Enter name below of Parent/Guardian/Student (if 18 or older). *
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Name of Parent/Guardian/Student (if 18 or older) per above agreement:
Registration & Tuition Deposit Payment will be sent as follows: *
Do you wish to continue dancing virtually, or would you like to attend in person when possible? *
In an effort to better serve our students we would appreciate information regarding any learning, health, or physical challenges. This will enable us to confidentially give our support, with knowledge and sensitivity. Please make any notes here or email us: sjd@sjd.dance. Thank you for your guidance.
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