Registration
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This form is to request a trial class for a dancer. No payment information is required. PDA staff will contact you to confirm the date and time of the requested class and answer any additional questions.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Relation to Dancer
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State/Prov:
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email For Newsletters:
Allergies (Leave blank if none):
Medications (Leave blank if none):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email For Newsletters:
Allergies (Leave blank if none):
Medications (Leave blank if none):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email For Newsletters:
Allergies (Leave blank if none):
Medications (Leave blank if none):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email For Newsletters:
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
Birth Date:
*
(format=mm/dd/yyyy)
Student Email For Newsletters:
Allergies (Leave blank if none):
Medications (Leave blank if none):
Questions/Options:
What class is your dancer interested in trying?
*
Additional Information:
Other Questions/Comments:
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