Registration
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"Bring a grown-up to dance day!" Dance 101 invites you to take class with your favorite dancer. When: Join your favorite dancer during their regular class time the week of November 27 - December 2, 2023. What: Guests will be dancing with us the entire class time. Guests must be dressed ready to move in comfortable clothing, socks and tennis shoes. Who: Only one guest per student/class. Guests must be at least 18 years of age. Participants must be registered prior to attending.
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
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- denotes required fields
Family Information
First Name:
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Last Name:
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Type
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Father
Grandparent
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
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
Zip:
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Emergency Contact Info
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Questions/Options:
What is the name of the grown up who is participating in class?
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What is the name of your student(s)?
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What class(es) will you be participating in?
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I am 18 years of age and I understand that I will be dancing and participating in class with my student.
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Yes
No
I understand that there will be photos and videos taken at this event by Dance 101 staff and other participants that may be used and displayed on social media and/or shared by others.
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Yes
No
I wish to declare the following medical conditions.
Additional Information:
Other Questions/Comments:
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