Registration
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Start your day in a fun, energizing way! This creative movement based mini-class is perfect for little ones, but will be fun for the whole family!
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Family Name
First Name:
*
Last Name:
*
Type
Caregiver
Father
Guardian
Mother
Other
Parent
Self
Teacher/Choreographer
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
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
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info (Not Contact #1 or #2)
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Gender Identity:
Female
Male
Non-Binary
Prefer to not disclose
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Race/Ethnicity (for grant reporting purposes):
:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Gender Identity:
Female
Male
Non-Binary
Prefer to not disclose
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Race/Ethnicity (for grant reporting purposes):
:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Gender Identity:
Female
Male
Non-Binary
Prefer to not disclose
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Race/Ethnicity (for grant reporting purposes):
:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Gender Identity:
Female
Male
Non-Binary
Prefer to not disclose
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Race/Ethnicity (for grant reporting purposes):
:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Gender Identity:
Female
Male
Non-Binary
Prefer to not disclose
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Race/Ethnicity (for grant reporting purposes):
:
*
Questions/Options:
Are you interested in learning more about our Virtual Dance Academy and the classes we are offering?
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Additional Information:
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