4.1.3. Dance Academy                                               Summer Intensive Registration
Please use the below form to begin your registration for the 4.1.3. Dance Academy Summer Intensives.

Please understand that the class(es) you choose below may already be full. I/we understand by submitting this registration form that I am aware and in agreement to all of 4.1.3. Dance Academy's policies and regulations.
Sign in to Google to save your progress. Learn more
Email *
Student Name (LAST, FIRST) *
Parent(s) Name (LAST, FIRST) *
Student Age *
Mailing Address *
Primary Phone Number *
How did you hear about 4.1.3. Dance Academy? *
Required
Name of Person Responsible For Payment *
I would prefer to pay by: *
Required
Does your student have any medical conditions or allergies that we should be aware of? *
Medical Release: In the event you are unable to reach me, or in the case of accident or injury, I give my permission for treatment as deemed necessary by staff at 4.1.3. Dance Academy or emergency personnel. I also release 4.1.3. Dance Academy and its staff of liability in case of injury or accident incurred to my student. (Initial Below)                                                                                   *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy