Request Information from Mathews Dance Studio
Please submit the following information. Class options and costs will be emailed to once age level has been processed.
Student Information
Please complete the following information about the STUDENT enrolling:
First Name *
Your answer
Last Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Gender
Allergies or Concerns
Your answer
Street Address Line One *
Your answer
City *
Your answer
Zip Code *
Your answer
Primary Contact Information:
Guardian preferred. This is the person who will receive class updates, be notified of emergencies and contacted first if classes are cancelled.
Name *
Your answer
Relationship to Student *
Your answer
Cell Phone Number *
Your answer
Home or Work Number
Your answer
Place of Employment
Your answer
Email Address *
Your answer
Secondary Contact Information:
This is the person who should be contacted if the primary contact cannot be reached in emergencies.
Name *
Your answer
Relationship to Student *
Your answer
Cell Phone *
Your answer
Email Address
Your answer
Would this contact like to receive monthly email updates about classes and upcoming events? (Contact one will automatically)
How did you hear about Mathews Dance Studio?
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