Student Information Form
Contact Information
Last Name *
Your answer
First Name *
Your answer
Performance Classes (Check all that apply) *
Required
Primary Address *
Your answer
Mother's Name *
Your answer
Father's Name *
Your answer
Mother's Cell Phone *
Your answer
Father's Cell Phone *
Your answer
Student's Cell Phone *
Your answer
Who shall we call in case of an emergency? Provide the number if not already listed above. *
Your answer
List any known allergies or medical conditions that we should know about. *
Your answer
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