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Ballet Basics (All ages) with Chanel
Join Chanel online for our all ages Ballet Basics class!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Account/Family Information
First Name:
*
Last Name:
*
Type
*
Dancer
Father
Grandfather
Grandmother
Guardian
Mother
Other
Parent
Partner
Spouse
Step Parent
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State/Prov:
*
Postal Code:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
Address Line 1:
Address Line 2:
City:
State/Prov:
Postal Code:
*
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