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2022-2023 Season: 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
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* Indicates required question
Email
*
Your email
Today's Date
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MM
/
DD
/
YYYY
Student's Full Name (as it appears on their birth certificate)
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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
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Your answer
City
*
Your answer
State
*
Your answer
Zip Code
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Your answer
Student's Cell (NOT parent's)
Your answer
Student's Date of Birth (a copy of the birth certificate is required)
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MM
/
DD
/
YYYY
School student Is attending
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Your answer
Grade for 2022-2023 school year
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Your answer
Please list any location student has danced, tumbled and/or cheered. (example: Tip Toes and Taps, Gateway, etc.)
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Your answer
Please list any previous experience student has in dance, tumbling and/or cheer (example: 2 years ballet and tap, 1 year hip hop, etc.)
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Your answer
Please list any allergies and anything we need to know. (example: peanut allergy - carries Epipen)
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Your answer
Please list any medical conditions and anything that we need to know. (example: asthma -carries inhaler)
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Your answer
If your child is not feeling well, may we give them any of the following medications?
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Ibuprofen
Acetaminophen
Allergy medication (like Benadryl)
Other:
Required
How did you hear about Tip Toes and Taps Dance and Tumble Zone?
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Friend
Social Media (Facebook, Instagram, Snapchat, etc.)
Employee of Tip Toes and Taps Dance and Tumble Zone
Other (Please fill in the space below to let us know how you heard about us.)
If you answered other above, please let us know how you heard about Tip Toes and Taps Dance and Tumble Zone in the space below.
Your answer
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.
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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
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