Spring 2018 Ballet Class Registration
Payment can be sent through PayPal (connectthedotsdancecompany@gmail.com):
Child's First and Last Name
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Child's Age
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Child's Gender
Child's Date of Birth
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Parent's First and Last Name
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Mailing Address
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Phone Number
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Email Address
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Emergency Contact Name
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Emergency Contact Phone Number
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Emergency Contact's Relationship to the Child
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Doctor's Name
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Doctor's Phone Number
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Waiver of Liability
I agree that I will not hold Connect the Dots School of Ballet or any faculty member liable for injuries sustained or illnesses contracted by my child while a student at Connect the Dots School of Ballet. If medical attention is required during class time, I understand that I will be contacted immediately. If I cannot be reached, I give my permission for an administrator of Connect the Dots School of Ballet to authorize treatment.
Class Location
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Class Day of the Week/Time
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Class Name
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