Registration Form

Students Name
Birth Date
Age
Previous Dance Training
Parent (s) / Guardian Name (s)
Address
Postal Code
Home Phone
Work Phone
E Mail Address

Class Choice
Choose a Class

Time Preference
Choose Preferred Time

Total Hours Per Week

Medical Information
Emergency Contact (other than parents)
Name
Phone Number
Cell Number
Relation to Student
Allergies ?                  Explain if Yes
Medications ?            Explain if Yes
Any Additional Information