Winter Dance Workshop Registration Form 2022

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Please complete the following information below. We are excited to host your child on Saturday, December 10 from 8:30 am - 12:30 pm.

Email *

Child's First Name *

Child's Last Name *

Child's Age *

Child's Grade in School *

Registration is now full as of December 9 for the following grade level groups: Pre-K, 1st grade, 2nd grade, 3rd grade - thank you for your understanding

Parents Names (Include first and last names for each parent as applicable) *

Best phone number to reach parent (mobile number preferred) *

School that my child attends: *

Is your child in the new Matilija Dance Class with Ms. Burright? *

Yes

If your child has any food restrictions, please note specifics below. If none, indicate n/a. *

Identify your child's preferred t-shirt size.

Note - we do our best to order shirt sizes based on request; registrations closer to the event date may not receive the precise shirt size to accommodate for the numbers we anticipate but cannot predict.

Please indicate that you have read and agree to the information below.

I agree to the participation expectations as described above.

If you have health insurance, please indicate the insurance company, policy number and group number below.

Signature: Please sign with your first and last name to complete this form. It is understood that this electronic signature is recognized as the same as a handwritten signature. *

If you know a Nordhoff Dancer that you hope will be your child's buddy, please list the high school student's name below.

A copy of your responses will be emailed to the address you provided.

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