Registration Form

Dancer Name *
Dancer Name
Phone *
Phone
Address *
Address
Primary Contact Information *
Primary Contact Information
Please fill in the primary parent or guardian contact information here.
Secondary Contact
Secondary Contact
Please fill in the secondary parent, guardian or emergency contact information here. Leave blank for none.
Secondary Contact Number *
Secondary Contact Number
Do you have any previous Dance training? *
How did you hear about us?
Emergency Contact Information
Emergency Contact Information
We follow very strict guidelines to ensure the safety of all of our dancers and staff, however accidents can happen anywhere. Please provide the following information for us to use in case of an emergency.
Emergency Contact Phone *
Emergency Contact Phone
Doctors Name *
Doctors Name
Doctors Phone *
Doctors Phone
Please provide any additional health information including any allergies, medial conditions or special instructions for us to know and understand.
Name
Name
YES, I acknowledge and give permission that my daughter's/son's picture may be used for publicity *
Approval *
Do you understand all of the information provided? As well as the disclaimer below
Signature