Registration

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Celebrate Halloween at Platinum on 10/27! All ages, families and friends welcome 12:30-1:30! Wear a costume, play games, make a craft, watch a movie and of course get candy!

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

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*

Students entered below will be added to your family's account

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:
	Previous Dance Experience:*

Additional Information: