Student Profile
Email address *
Dancer's Full Name *
Your answer
Dancer's Age: *
Your answer
Dancer's Birthday : *
MM
/
DD
/
YYYY
Parent/Guardian Full Name: *
Your answer
Parent/Guardian Cellphone #: *
Your answer
Parent/Guardian Email Address: *
Your answer
Home Address: *
Your answer
Emergency Contact: *
Your answer
Relationship to Dancer: *
Your answer
Cellphone #: *
Your answer
Siblings & Ages: *
Your answer
Pets: *
Favorite Activities: *
Your answer
List any previous dance experience: *
Your answer
List any orthopedic injuries, diagnosis, surgeries we need to know about: *
Your answer
Are there any medical issues that we need to be aware of? *
Your answer
How does your child feel about physical touch? *
Your answer
Which class or classes will your student take part in? *
Required
YOUR COMMITMENT: *
If your dancer needs more assistance than we are able to support, you may be required to participate with your child. * One parent/guardian per dancer must agree to be in attendance for the duration of each class.
Required
Who will normally be waiting for your child during class: *
Your answer
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