4.1.3. Dance Academy Summer Intensive Registration
Please use the below form to begin your registration for summer classes with 4.1.3. Dance Academy. Please understand that the classes you choose below may already full as we will have limited class spaces. We will email you with an invoice and official classes.
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Email *
Student Name (first, last) *
Parent(s) Name (first, last) *
Student Age *
Student Date of Birth *
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Mailing Address *
Primary Phone Number *
Name of Person Responsible For Payment *
How did you hear about 4.1.3. Dance Academy? *
Required
Prior Dance Experience (if not a current 4.1.3. dancer) to help in placement of class(es)
Does your student have any medical conditions or allergies that we should be aware of? *
Medical Release: In the event you are unable to reach me, or in the case of accident or injury, I give my permission for treatment as deemed necessary by staff at 4.1.3. Dance Academy or emergency personnel. I also release 4.1.3. Dance Academy and its staff of liability in case of injury or accident incurred to my student. (Initial Below)                                                                                   *
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