Dance and Cheer and gymnastics Class Registration Form
Future Dance , Little Burton , Kennington
Name of child 1
First Name
Last Name
Name of child 2
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
Emergency Contact Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Photograph and video Consent
I give consent for my child’s image to be used
I do not give consent for my child’s image to be used
Please write the dates and classes you would like your child to attend
Please complete the payment form which is attached below . If you are paying cash please let me know in the box below .
Medical Conditions or Allergies
Signature
Date signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pay Here
Submit
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