Session 2018-2019 Class Online Registration Form

Session Class Registration Information includes:

  • Parent/legal guardian information
  • Emergency contact information
  • Student information 
    (Up to three students, or up to three classes, may be registered at once)

* Required fields
Name *
E-mail Address *
Address *
City *
State *
Zip Code *
Home Phone *
Alternate Phone
Emergency Contact Name *
Emergency Contact Phone *
Student 1: Name *
Student 1: Age *
Student 1: Birthdate (mm/dd/yyyy) *
Student 1: School 2018-2019
Student 1: Grade 2018-2019
Student 1: Years Of Dance *
Student 1: Class Choice *
Student 1: Are there any health issues of which we should be aware?
Student 2: Name
Student 2: Age
Student 2: Birthdate (mm/dd/yyyy)
Student 2: School 2018-2019
Student 2: Grade 2018-2019
Student 2: Years Of Dance
Student 2: Class Choice
Student 2: Are there any health issues of which we should be aware?
Student 3: Name
Student 3: Age
Student 3: Birthdate (mm/dd/yyyy)
Student 3: School 2018-2019
Student 3: Grade 2018-2019
Student 3: Years Of Dance
Student 3: Class Choice
Student 3: Are there any health issues of which we should be aware?
Comments
How Did You Hear About Us? *
Referred By
We ADD Classes Based Upon Interest! What would you be interested in seeing? (examples: boys-only, Zumba, acrobatics, dancing moms & dads, etc.)


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