Step It Up Registration Form
This is the official form to register as a student of our studio. 
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Parent(s)/Guardian: *
Today's Date: *
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 Address: *
City, State, Zip *
Phone Number:  *
Second Phone Number:
Email address:  *
Emergency Contact (other than parents): *
Contact Phone Number: *
Student Information
Student Name:  *
Date of Birth:  *
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Student 2 Name: 
Date of Birth: 
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Student 3 Name: 
Date of Birth:
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Student 4 Name: 
Date of Birth:
MM
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Medical Information
Has the student(s) had any serious injuries? *
Does the student(s) take any medications on a regular basis? *
If yes, please explain:
If yes, please explain:
Doctor's Name:  *
Does the student(s) require any special medical care? *
If yes, please explain:
Doctor's Phone Number:  *
Hospital: *
Hospital Phone Number: *
Any additional information we should know about the student(s)?
How did you hear about us? *
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