StudentDancer's Name* First Last Preferred Contact Email* Preferred Contact Phone*Address Date of BirthDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Style of Dance Ballet Jazz Pre School Dance Adult Class Contemporary Please list an information that will assist us in giving your dancer the best experience possible.i.e, medical conditions, learning disabilities, preferred pronouns etc.This information will be kept confidential.Parent / CaregiverName* First Last Relationship to Dancer Different/alternative emergency contact? Different Phone Number Different Email Address Different Address Parent / Caregiver Phone*Parent / Caregiver Email* Parent / Caregiver Address* Consent* I have read and agreed to the terms and conditions Δ