Registration
Branches of Dance 2023-2024 Registration Form
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denotes required fields
Referral Information
How did you hear about us?
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Coloring Pages
Facebook
Instagram
Internet
Internet Search
Other
Performance
Postcard
Referral
Walk-in
Website
Referral Name
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Family Information
Family Last Name
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Where do you live?
Home Address
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City
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State
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip
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Primary Phone
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Additional Info
Emergency Contact Info (Not Contact #1 or #2)
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Contact #1
Contact #1 First Name
*
Last Name
*
Type
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Caregiver
Father
Guardian
Mother
Parent
Self
How Can We Contact You?
Home Phone
Cell #
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Email
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(Emails are kept confidential)
Confirm Email
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Contact #2
Contact #2 First Name
Last Name
Type
Caregiver
Father
Guardian
Mother
Parent
Self
How can we contact you?
Home Phone
Work #
Cell #
Email
(Emails are kept confidential)
Confirm Email
Who is your employer?
Employer
Employer Phone
Employer Notes
Student #1
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
Disabilities (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #2
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
Disabilities (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
Disabilities (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
Disabilities (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
Disabilities (Leave blank if NONE)
Allergies (Leave blank if NONE)
Add Another Student
Required Policies
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I Agree to All of the Above
Enter your Full Name
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April 25, 2024
Questions or Concerns
Comments
Payment Information
Account Information
e-Payment Schedule
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Card Nickname
Name as it appears on card
Address Line 1
Address Line 2
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip
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