PD Dance Days

PD Dance Days

2024/2025 Registration Form
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Age as of Jan 1, 2025*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Any medical conditions or allergies we need to be aware of*
Parent/guardians name*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.

Calculation
Convenience Fee
Total
Total

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CADDescription

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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