Contact information
**PLEASE NOTE: Registration is not complete until payment is received. **
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Email *
Please select which course you are registering for:
*
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Student Name *
Date of Birth *
MM
/
DD
/
YYYY
Dance Experience?
If choosing other, please list below:
Please list any allergies, medical or physical conditions that we should be aware of.
Parent/Guardian #1 *
Phone number *
Email
Address *
Billing Address (If different than address above)
Parent/Guardian #2
Phone
Email
Address (If different than above)
Emergency Contact *
Phone number *
Relationship to Student *
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