JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Student Registration Form
Tip Toes and Taps Dance and Tumble Zone
Address: 452 West Martintown Road, North Augusta, SC 29841
Website:
www.tiptoesandtaps.net
Email:
info@tiptoesandtaps.net
Phone: 803-278-3841
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Student's Full Name (as it appears on their birth certificate)
*
Your answer
Does your child have a nickname that they like to go by? If so, please list it here.
Your answer
Please select the gender of the student.
*
male
female
Street Address or PO Box
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Student's Cell (not parent's)
Your answer
Student's Date of Birth (a copy of the birth certificate is required)
*
MM
/
DD
/
YYYY
School student Is attending
*
Your answer
Grade
*
Your answer
Please list any previous experience student has in dance and/or tumbling
*
Your answer
Please list any allergies and medical issues student has
*
Your answer
If your child is not feeling well, may we give them any of the following medications?
*
Ibuprofen
Acetaminophen
Allergy medication (like Benadryl)
Other:
Required
Parent/Guardian's First and Last Name (as it appears on ID - a copy of your drivers license or photo ID required)
*
Your answer
Is parent/guardian military (active or veteran), police officer, firefighter or EMT? If so, provide proof and you will receive a 10% discount off your tuition.
*
Yes
No
Parents Cell Phone Number
*
Your answer
Home Phone (If different from cell)
Your answer
Employer
Your answer
Manager/Supervisor's Name
Your answer
Employer's Phone number
Your answer
Other Parent/Guardian's First and Last Name (as it appears on ID - a copy of your drivers license or photo ID required)
*
Your answer
Is parent/guardian military (active or veteran), police officer, firefighter or EMT? If so, provide proof and you will receive a 10% discount off your tuition.
*
Yes
No
Other Parent/Guardian's Cell Phone Number
*
Your answer
Home Phone (If different than cell)
Your answer
Other Parent/Guardian's Email Address
*
Your answer
Other Parent/Guardian's Employer
Your answer
Other Parent/Guardian's Manager/Supervisor's Name
Your answer
Other Parent/Guardian's Employer's Number
Your answer
Student lives with
*
Mother
Father
Both Mother and Father
Grandparent
Other: If other please explain below.
If other, please explain.
Your answer
If there are any custody issues we need to know about, please explain and provide the necessary paperwork.
Your answer
Please list everyone approved to pick up your child.
*
Your answer
Next
Page 1 of 6
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
