PlacerDance Registration Form
Please review the Dress and Behavior Code (see tab above) before registering
Name
*
First Name
Last Name
E-mail
*
Send me info for all PlacerDance events
Only send me info for the current event (Prom)
Today's Date
-
Month
-
Day
Year
Date Picker Icon
Birthdate
*
-
Month
-
Day
Year
Date Picker Icon
# of Days
Age
Grade
*
Please Select
Freshman
Sophomore
Junior
Senior
Homeschool Liaison
Anticipated HS Graduation Year
*
Please Select
2018
2019
2020
2021
Homeschool Liaison
My School of Record is:
*
An independent homeschool (PSA)
A public homeschool charter
A site-based public charter
Other
Sex
*
Male
Female
Types of partner dances you would like to learn
Ballroom
Country
Salsa
Swing
Are you interested in attending a Junior/Senior Homeschool Prom and banquet in Auburn?
Yes-Banquet and Prom
Yes-Prom only
No
City
Parents' names
*
Parents' email
*
Submit
PlacerDance@gmail.com
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