Registration Name of Student * First Name Last Name Date of Birth * Name of Student First Name Last Name Date of Birth Name of Student First Name Last Name Date of Birth Name of Student First Name Last Name Date of Birth Name of Parent/Guardian * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact * Name, phone number and relation to student. Please describe any medical conditions, medications, health concerns or allergies. * For the safety of the dancer(s), please note that our team will be made aware of all medical conditions. All information will be kept confidential. Thank you!
