ACRO INTENSIVE - Summer 2023
AUGUST 21st & 22nd 2023
Participant's Name
*
Given Name
Surname
Participant's Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Allergies/Medications
Please list dancer's current allergies, any medication they take regularly or any previous injuries the staff should be aware of.
Sessions attending: (select ONE or BOTH options)
Monday, August 21st
Tuesday, August 22nd
Parent/Guardian Name
*
Primary emergency contact
Parent/Guardian E-mail
*
Emergency Contact Phone Number
*
Preferred Payment Method:
Credit Card (Invoice will be provided by email)
Credit Card on File (for returning dancers with card info saved on file)
E-Transfer (to jacqueline@studio12dance.com)
To secure a spot, payment in full is required. Payments are non-refundable.
*
I UNDERSTAND
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