Student Application Form

    Student Information

     

    Students Name :

     

    Age :

     

    Date of Birth :

    What classes are you interested in? (Check all that apply)

     

    Ballet    Tap    Jazz    Hip Hop    Fusion    Other

     

    Other Dance Class :

    Mother's Information

     

    Mother's Name :

     

    Home Phone :

    Cell Phone

     

    Work Phone :

    Email :

     

    Place of Employment :

    Fathers's Information

     

    Father's Name :

     

    Home Phone :

    Cell Phone

     

    Work Phone :

    Email :

     

    Place of Employment :

    Mailing Address

     

    Mailing Address 1 :

     

    Mailing Address 2 :

     

    Mailing Address 3 :

    School Information

     

    Child's School :

     

    Grade :

    Phone Number :

    Emergency Contact Information

     

    Contact Name :

     

    Phone Number 1 :

    Phone Number 2 :

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