2022 Enrollment Form
2022-2023 Enrollment for for Maria's School of Dance
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Email *
Student Last Name *
Student First Name *
Student Age as of September 1, 2022 *
Student Date of Birth *
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/
DD
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Student Cell Phone (if applicable)
Student Grade as of September 2022 *
Primary email address for communication *
Guardian #1 relationship to student *
Guardian #1 First and Last Name *
Guardian #1 Address (Street, City, State, Zip) *
Guardian #1 Phone Number *
Guardian #2 relationship to student
Guardian #2 First and Last Name
Guardian #2 Phone Number
Person responsible for the account: First and Last Name *
Person responsible for the account: Address (Street, City, State, Zip) *
Person responsible for the account: Email Address *
Person responsible for the account: Phone Number *
Emergency Contact: Name and Phone Number *
Allergies or other health concerns *
I wish to enroll in the following classes. (All class assignments will be at teacher's discretion)
Dance Experience (New Students ONLY)
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