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 *
Cell Phone *
Emergency Contact Name *
Emergency Contact Phone *
Student 1: Name *
Student 1: Age *
Student 1: Birthdate (mm/dd/yyyy) *
Student 1: School 2019-2020
Student 1: Grade 2019-2020
Student 1: Years Of Dance *
Student 1: Class Name *
Student 1: Class Day *
Student 1: Class Time *
Student 1: Class Teacher *
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 2019-2020
Student 2: Grade 2019-2020
Student 2: Years Of Dance
Student 2: Class Name
Student 2: Class Day
Student 2: Class Time
Student 2: Class Teacher
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 2019-2020
Student 3: Grade 2019-2020
Student 3: Years Of Dance
Student 3: Class Name
Student 3: Class Day
Student 3: Class Time
Student 3: Class Teacher
Student 3: Are there any health issues of which we should be aware?
Comments
How Did You Hear About Us? *
Referred By:
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Copyright 2019 Lake Area Dance Center, LLC. All rights reserved.