Registration Form
A separate form must be received for each student.
Date
-
Month
-
Day
Year
Date
Student Name
First Name
Last Name
Birth Date
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
3
4
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31
Day
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
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1946
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1943
1942
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1940
1939
1938
1937
1936
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1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
Address
Street Address
Street Address Line 2
City
State / 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
Ballet
Tap
Jazz
Lyrical
Modern
Hip Hop
Other
How Did You Hear About Us?
From a friend
Facebook
Instagram
Our Sign
Other
Academic School Attending In The Fall
Grade
Preferred Dance Class Days/Times For Classes Beginning in September
Mother's Name
First Name
Last Name
Father's Name
First Name
Last 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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