Course Registration Form

Registration Form

A separate form must be received for each student.
Date

MonthDayYear
Date
Student Name

First NameLast Name
Birth Date

MonthDayYear
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Phone Number
Alternate Number
Years of Dance Training Completed
Year First Attended Dance School
Select Disiplines Studied

BalletTapJazzLyricalModernHip HopOther
How Did You Hear About Us?

From a friendFacebookInstagramOur SignOther
Academic School Attending In The Fall
Grade
Preferred Dance Class Days/Times For Classes Beginning in September
Mother's Name

First NameLast Name
Father's Name

First NameLast Name
Occupation
Occupation
Employer's Name
Employer's Name
Work Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Emergency Contact
Phone
Please enter a valid phone number.
Signature

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