Student Application Form Student Information Students Name : Age : 34567891011121314151617181920 Date of Birth : JanFebMarAprMayJunJulAugSepOctNovDec 12345678910111213141516171819202122232425262728293031 200320042005200620072008200920102011201220132014201520162017201820192020 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 : [recaptcha]