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Summer Adult 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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Today's Date
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Full Name (as it appears on your birth certificate)
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Do you have a nickname that you like to go by? If so, please list it here.
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Please select your gender.
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Street Address or PO Box
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City
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State
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Zip Code
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Cell Phone number
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Date of Birth
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Are you attending school? If so which school/college.
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Course of study
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Please list any previous experience you have in dance.
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Please list any allergies and medical issues that we need to be aware of. (Asthma, peanut allergy, etc.)
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Are you or your spouse 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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Employer
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Manager/Supervisor's Name
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