Duet- SRB Registration Form
Please fill out the form and send us back.
Student's Name
*
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Student's Name (sibling #2)
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Student's Name (sibling #3)
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Parent's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Classes interested in
Ballet
Dance Movements (ages 6 - 7)
Contemporary and Gymnastic (8 - 10)
Acro
Lyrical (ages 7 and up)
Hip Hop (ages 6 and up)
Creative movement (18 months-2 years)
Pre-School (ages 3-5)
Adult Tap/Jazz
Please list any allergies or medical conditions your child has that we need to be aware of
*
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