Training Program Registration Form

Training Program Registration Form
Student Information
Name

First NameLast Name
Age*
Gender

MaleFemale

2024 CLASS SCHEDULE
11/09/24	11:15- 12
11/16/24	11:15-12
11/23/24	11:15-12
11/30/24	Thanksgiving Break -Closed

Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Write something about yourself
Parent/Guardian Information

For minors (below 18 years of age)
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship
Shirt Size

SMLXLXXL
Payment & Confirmation
Payment Method

CashCheckCash App ( $Dsimonestudioofdance)
Signature of Student

Clear
Date Signed

MonthDayYear
Date
Parent/guardian Name

First NameLast Name
Parent/guardian Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty: