Registration

Registration

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Event:

Start Date/Time:

End Date/Time:

Fee per Family:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:*	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info

Add New Student #1:

(Show-Hide Details)

	Student's First Name: *	Last Name: *
	Student Gender:	Birth Date: * (format=mm/dd/yyyy)
	Student Email:
	School:	Grade Level:
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):
	Primary Doctor:

Questions/Options:


Please Choose your 1st class: Dance, Music, Theatre, Visual Arts
Please Choose your 2nd class: Dance, Music, Theatre, Visual Arts
How did you hear about us?

Additional Information:

Other Questions/Comments: