Exposure Dance Studio
Season 13 Registration: September 2018-June 2019
Email address *
Student's Name: *
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Parent/ Guardian Name: *
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Address (Please Include City, State, Zip Code): *
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Home Phone Number:
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Cell Phone Number:
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Email Address: *
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Emergency Contact (Name & Phone number Please put someone other than the above contact): *
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Credit Card-Every account MUST have a card on file. Your credit card will ONLY be charged before Recital if you have an outstanding balance. (Please indicate Card Number, Expiration Date, Security Code, & Billing Address): *
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Student's Birth Date (Month/Day/Year): *
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Student's School and Grade: *
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Allergies:
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Previous Dance Experience? If So, Where? *
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This will be my ______ year dancing: *
Required
Which classes are you registering for? Please include CLASS NAME, DAY, TIME, & TEACHER (See "Schedule" page for days and times): *
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Recital T-Shirt Size(You will be billed at a later date): *
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Questions or Comments?:
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How did you hear about us?: *
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A copy of your responses will be emailed to the address you provided.
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