NW Dance and Acro Online Registration

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NW DANCE AND ACRO REGISTRATION FORM

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Referral Information

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Referral Name*

Family Information

Family Last Name*

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Home Address*

City*

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Contact #1

Contact #1 First Name*

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Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

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Medications (Leave blank if NONE)

Primary Doctor

Please note that we reserve the right to modify registration in a class based on directors discretion.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please note that we reserve the right to modify registration in a class based on directors discretion.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please note that we reserve the right to modify registration in a class based on directors discretion.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please note that we reserve the right to modify registration in a class based on directors discretion.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please note that we reserve the right to modify registration in a class based on directors discretion.

Enroll in Classes

Select Class *

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Payment Information

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Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

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Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

Additional Info

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