Registration Form
2020-2021 Children's Dance Program
Student's First and Last Name *
Student's Gender *
Student's Age and School Grade *
Student's Membership Status *
Parent's First and Last Name *
Parent's Contact Phone Number *
Parent's Email Address *
Student's Allergies *
Other Medical Conditions *
Emergency Contact Name & Relationship *
Emergency Contact Phone Number *
Classes/Enrollement - check all that apply *
Agree to Registration Fee (nonrefundable) *
Credit Card Number & Exp Date *
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