2025-2026 ESOTA Registration Form

Student Name

First NameLast Name

Parent/Guardian #1

First NameLast Name

Parent/Guardian #2

First NameLast Name

Mailing Address

Street Address

Apartment Number if applicable

CityState / Province

Postal / Zip Code

Student's Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent #1's Home Phone

Please enter a valid phone number.Format: (000) 000-0000.

Parent #1's Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent #2's Home Phone

Please enter a valid phone number.Format: (000) 000-0000.

Parent #2's Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Student's Email

example@example.com

Parent's Email #1 (for class distribution lists)

example@example.com

Parent's Email #2 (for class distribution lists)

If none, write n/a.

Emergency Contact #1 Name

Contact Name (other than parent listed)

Emergency Contact #1 Phone

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact #1 Relationship

Relationship to student

Emergency Contact #2 Name

Contact Name, other than parent listed. If a second contact not available, please write n/a

Emergency Contact #2 Phone

Please enter a valid phone number. If none, write n/a.Format: (000) 000-0000.

Emergency Contact #2 Relationship

Relationship to student. If none, write n/a.

Student's Age

Date of Birth

Student's Academic School

Student's Grade

How did you hear about ESOTA?

Student Enrollment - Select One

Please indicate your child's enrollment status

Pick Up Restrictions/Court Orders

Please list any details. If none, write n/a.

Is there a court order in effect? If so, please upload a copy.

Court Order File Upload

Please upload any court order in effect if applicable

Previous Dance Experience - schools attended and number of years at each

Please list any previous dance experience. If none, write n/a.

Other Relatives Enrolled in ESOTA

Please list the name(s) and relationship to any current or former ESOTA students. If none, write n/a.

Does the Student have Consent to Walk Home Alone?

Does the Student have Consent to Leave the Building for Lunch?

Medical Conditions

Please list any medical conditions, including allergies and medications taken. If none, write n/a.

Parent's Occupation

Please list the occupation of parent(s)/guardian(s). If none, write n/a.

Classes - please select all classes your child will take (please review schedule) Consecutive classes required of Babies and Children's class students

Please check your child's class name. Classes are based on the child's age. PEP classes should only be selected by those who were enrolled in one of these classes during the 2024-2025 Season.

Is your child vaccinated?

If so, please upload a copy of the most recent vaccination record. It is not required for registration at this time.

Please upload copy.

Signature

Date

ESOTA 2025-2026 Registration Form