Dancer Information for 2024 Dance Season

1

Diva's Name* This field is required.

First Name

Last Name

2

Diva's Date of Birth* This field is required.

Date

3

Diva's Current Grade in School (List N/A if diva has not started school yet)* This field is required.

4

If you have another child to register, please add their information. Otherwise, leave the following boxes blank and proceed to Parent/Guardian information by clicking "Next".

5

Diva #2 Name

First Name

Last Name

6

Diva #2's Date of Birth

Date

7

Diva #2's Current Grade in School (List N/A if diva have started school yet)

8

Diva #3's Name

First Name

Last Name

9

Diva #3's Date of Birth

Date

10

Diva's Current Grade in School (List N/A if diva have started school yet)

11

PARENT/GUARDIAN NAME* This field is required.

First Name

Last Name

12

Parent/Guardian Email Address* This field is required.

example@example.com

13

Parent/Guardian's Phone Number* This field is required.

14

Emergency Contact NAME* This field is required.

First Name

Last Name

15

Emergency Contact's Phone Number* This field is required.

16

Does your diva(s) have any medical history or concerns? (i.e. Previous concussions, knee/ankle brace, asthma, etc.) If your diva has asthma, we must have an asthma pump on-site. Please label the pump with your diva's first and last bane and place it in a zip lock bag. NO EXCEPTIONS!* This field is required.

17

Does your diva have any allergies? If so, please list them below.* This field is required.

18

In the event of any emergency, we will make every reasonable attempt to contact the dancer's parent/guardian or emergency contact (except for life-threatening injuries). If we are unable to reach you or your emergency contact, do you authorize M&T Performing Arts to seek emergency medical assistance on behalf of your diva(s)?* This field is required.

19

Preferred Hospital in case of an emergency:* This field is required.

20

I have read the rules and agree to abide by said rule. I am aware that my diva may be dismissed from the team by not following said rules. Parent/Guardian Signature* This field is required.

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21

I have read the policy regarding Dress Code and Personal Items and agree to abide by said Rule. Parent/Guardian Signature* This field is required.

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22

I have read the above rule regarding dismissal and agree to abide by said rule. Parent/Guardian Signature* This field is required.

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23

I have read the information regarding tuition and I agree to abide by said agreement. Parent/Guardian Signature* This field is required.

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24

I have read the Confidentiality Clause and agree to abide by said clause. Parent/Guardian Signature* This field is required.

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25

I have read the Acknowledgement, Waiver & Release of Liability and agree to abide by said acknowledgement. Parent/Guardian Signature* This field is required.

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26

Name of Parent/Guardian Completing this Form

First Name

Last Name