Chaban Ukrainian Dance Regina Registration 2019-20
Classes run from September 2019 - May 2020 *Please complete - one form per dancer*
Class - Please select the class you wish to register for. *
DANCER INFORMATION
Please complete
Family (Last) Name *
Your answer
Given (First) Name *
Your answer
Gender *
Birthdate (dd/mm/year) *please update year *
MM
/
DD
/
YYYY
Age as of September 1, 2019 *
Your answer
Street Address *
Your answer
City *
Your answer
Postal Code (xxx xxx) *
Your answer
Phone Number (Home w/area code) *
Your answer
Cell Number w/area code *
Your answer
Email Address *
Your answer
Parent/Guardian (Primary Contact information-if not applicable please state n/a) *
Your answer
Address/Phone Number (if different from the one provided with child's information) *
Parent/Guardian (Secondary Contact Information-if not applicable please state n/a) *
Your answer
Address/Phone Number (if different from the one provided with child's information)
*
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