Student & Parent Info
Please fill out the form below to enroll.
Student's Full Name *
Your answer
Parent's Full Name *
Your answer
Date of Birth *
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/
DD
/
YYYY
School Grade *
Full Address *
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Primary Phone *
Your answer
Secondary Phone
Your answer
Primary Email Address *
Your answer
Secondary Email Address
Your answer
How did you hear about Ellens School of Dance? *
If by referral, who?
Your answer
If other, what?
Your answer
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