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Trial Class Intake Form
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Email *
Parent First & Last Name *
Student First & Last Name *
Mobile Number (for texting) *
Student Gender *
Student Age *
Student Date of Birth *
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Previous Dance Experience *
Previous Studio (if applicable)
What style(s) would you like to try? *
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How did you hear about MDM?
Please provide any additional information that would be useful in helping us make the right class suggestions. 
A copy of your responses will be emailed to the address you provided.
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