Student Registration Form
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Contact Information
Name of Dancer *
Birthdate *
MM
/
DD
/
YYYY
Name of Guardian (if under 19*)
Phone Number *
Email  *
Class Selection
Please select all classes for this one dancer. Please use a new form for siblings/household dancers
Which class(es) are you registering for? *
Required
Emergency Contact
Name *
Phone Number *
Dancer Health Info
Does this dancer have any allergies? If so, do they carry an epi-pen? *
Does this dancer have any current or past injuries that may impact their ability to dance and/or participate fully in class? If so, please include any relevant details on their recovery plan. *
Does this dancer have any medical conditions that will restrict or impact their ability to participate fully in class, or that may require medication throughout class? *
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