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