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Zhaoli Dance School Registration Form
Below is the registration form for the 2021-2022 dance year.
Address: 110 Country Hills Landing NW #1, Calgary, AB T3K 5P3
Phone: (403) 852-6971
Website:
http://www.zhaolidance.com/
Email:
zhaolidanceschool@gmail.com
**Full payment due upon registration**
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Email
*
Your email
Student Information (學生個人資料)
(PLEASE PRINT CLEARLY)
Student's LAST NAME
*
Your answer
Student's FIRST NAME
*
Your answer
Student's Chinese Name (學生中文名)
*
Your answer
Date of Birth (出生日期)
*
MM
/
DD
/
YYYY
Address (住址)
*
Your answer
Postal Code (郵編)
*
Your answer
Home Phone (住宅電話)
Your answer
Cell Phone (手提電話)
*
Your answer
Emergency Contact FULL NAME (緊急聯絡人)
*
Your answer
Emergency Contact's Phone (聯絡電話)
*
Your answer
Medical Information
All information is strictly confidential / for office use only.
** If none, please input "N/A"
Chronic Injuries / Restrictions (慢性運動損傷或限制)
*
Your answer
Medical Conditions /Allergies (醫療條件/過敏原)
*
Your answer
Name of School AND Grade (學校及年級)
*
Your answer
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