S&R Dance Registration Form
S&R Dance - Freeport, IL
Student Information
(Dancer #1)
Full Name:
*
First Name
Last Name
Birthdate:
*
-
Month
-
Day
Year
Date
Grade:
*
Classes interested in:
*
Mommy & Me
Tiny Tots
Creative Movement
Dance- Tap & Jazz
Hip Hop
Ballet
Lyrical
Jazz Technique
Parent/Child Tap
Adult Tap
Adult Jazz/Hip Hop
Dads Dance
Father/Daughter
Family Dance
Tumbling
Private Lessons
Competitive Program/Audition Class
Dance Season:
*
Fall
Summer
Fall & Summer
Student Information
(Dancer #2 - 25% Tuition Discount excluding Private Lessons)
Full Name:
First Name
Last Name
Birthdate:
-
Month
-
Day
Year
Date
Grade:
Classes interested in:
Mommy & Me
Tiny Tots
Creative Movement
Dance- Tap & Jazz
Hip Hop
Ballet
Lyrical
Jazz Technique
Parent/Child Tap
Adult Tap
Adult Jazz/Hip Hop
Dads Dance
Father/Daughter
Family Dance
Tumbling
Private Lessons
Competitive Program/Audition Class
Dance Season:
Fall
Summer
Fall & Summer
Student Information
(Dancer #3 - 25% Tuition Discount excluding Private Lessons)
Full Name:
First Name
Last Name
Birthdate:
-
Month
-
Day
Year
Date
Grade:
Classes interested in:
Mommy & Me
Tiny Tots
Creative Movement
Dance- Tap & Jazz
Hip Hop
Ballet
Lyrical
Jazz Technique
Parent/Child Tap
Adult Tap
Adult Jazz/Hip Hop
Dads Dance
Father/Daughter
Family Dance
Tumbling
Private Lessons
Competitive Program/Audition Class
Dance Season:
Fall
Summer
Fall & Summer
Parent/Guardian Information
Parent/Guardian Name:
*
Relationship to Dancer:
*
Phone Number:
*
-
Area Code
Phone Number
Emergency Contact Name:
*
Relationship to Dancer:
*
Phone Number:
*
-
Area Code
Phone Number
Parent/Guardian Contact Information:
Email Address:
*
example@example.com
Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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SUBMIT
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