Dance Acknowledgment of Course Policies
Mrs. Siegel 
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Student Last Name *
Student First Name *
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TO BE COMPLETED BY STUDENT: Please READ and THEN select all boxes.  *
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STUDENT: Please type name below, in acknowledgement of the statements above.  *
TO BE COMPLETED BY PARENT: Please READ and THEN select all boxes.  *
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PARENT: Please type name below, in acknowledgement of the statements above.  *
TO BE COMPLETED BY GUARDIAN: Is there anything else that is important for me to know in order to help your student to be successful in class this year? *
MESSAGE TO GUARDIAN:
If there is anything else that is important for me to know in order to help your student be successful in class this year, please reach out to me via email at: rsiegel@srvusd.net
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