Vibration Dance Project
2018/2019 Dance Season
Students Name *
Your answer
Parent Name *
Your answer
Email *
Your answer
Mailing Address
Your answer
Student Date of Birth *
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Current Age of Student *
Your answer
Prior dance experience? *
Your answer
Best Contact Number *
Your answer
Emergency Contact Information *
Your answer
Does your student have any physical limitations or allergies? *
Your answer
Give us a brief description of why you or your child would like to be part of the program. *
Your answer
Contract Information
By signing, I am saying that my student is physically healthy enough to begin this program. I further understand that this is NOT a program designed to diagnose or treat any mental of physical health issues. We are a mentoring program to be used in addition to other treatment plans by your family health care provider. We are not resposible for implementing tretment plans.
I understand & agree with the contract information *
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We will be contacting you shortly about class availability
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