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Student Information Form and Liability Release 2024-2025
This must be completed for each student every year.
* Indicates required question
Email
*
Record my email address with my response
Student Name
*
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Student Mobile Number:
Your answer
Student Email Address
Your answer
Student's School
*
Your answer
Student's Grade
*
Your answer
What time do you get out of school?
*
Your answer
Previous Dance Training:
Your answer
Where are you currently dancing?
Your answer
How did you hear about the studio?
Your answer
Primary Parent/Guardian
*
Your answer
Relationship to student:
*
Your answer
Parent Mobile Number
*
Your answer
Additional Parent/Guardian/Relative
Your answer
Relationship to Student
Your answer
Additional Mobile Number
Your answer
Additional email address:
Your answer
Person Responsible for Account Payment:
*
If different than above, please include contact information
Your answer
Are there any allergies, health or behavioral issues, family situations or other special circumstances that I should be aware of?
*
Your answer
I like to support my students' families in their own businesses! If you have a business, work locally or provide a service in the area please let me know.
*
Your answer
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