Dance Club Registration Form
LIMITLESS POSSIBILITIES COMMUNITY CENTER
Student's Name
*
First Name
Last Name
Birthdate
*
/
Month
/
Day
Year
Date
Parent's Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Class(es) Interested In
*
Ballet
Tap
Jazz
Hip Hop
Please list any allergies or medical conditions your child has that we need to be aware of
*
Signature
*
Date
-
Month
-
Day
Year
Date
Should be Empty: