Dance Buddies registration form

Dance Dimensions Dance Buddy Program

2024-2025 Registration Form
Dancers Name:*

First NameLast Name
Dancers Birthdate*
Dancers Age*
Parent/Guardian #1 Name*

First NameLast Name
Parent/Guardian #1 Cell Phone Number*
Please enter a valid phone number.
Parent/Guardian #1 Email address*
example@example.com
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Cell Phone Number
Please enter a valid phone number.
Parent/Guardian #2 Email
example@example.com
Primary Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact name (must be different than parent information)

First NameLast Name
Emergency Contact Cell #
Please enter a valid phone number.
Please list students diagnosis and any medical information (including allergies) to assist us in providing your dancer an amazing experience.*
I, (parent/guardian name) blank*do herby release from all liability Dance Dimensions, LLC for all injuries or illness sustained during the course of dance or dance-related study on the physical premises of Dance Dimensions, LLC, Brookfield, CT or virtually. There will be a $35.00 charge for returned checks. I further understand that tuition and registration fee is not refundable. I also give permission for the above publicity to be photographed for publicity or advertising use. blank*
Parent/Guardian signature
Should be Empty:

Dance Dimensions Dance Buddy Program