Student Registration form
Contact form for correspondence about classes at Elixir Dance.
 Please fill out all the boxes that apply. You will receive a response from us shortly after completion. 
**Your information is stored safely and not shared with any third party. 
We look forward to meeting you in class!
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Email *
Dancers Name     *
Dancer's date of birth *
MM
/
DD
/
YYYY
Parents name  *
Parents address  *
Phone number *
Allergies (please name) *
Emergency contact name and phone number  *
How did you hear about the classes? *
What class are you interested in? *
Required
Experience / classes taken previously *
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