Registration
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Welcome to Adult Hip Hop with Miss Lindsey! If you have previously attended a pop-up class or are an existing Dance Arts student and have a portal account, please click the link above. If you are NEW to Dance Arts, please complete the form below. Once you complete the top Family Information Section, you will need to complete the Add New Student Section before form can be submitted. Fee for the class is $20. Payments can be made in advance through Venmo @DanceArts-Merrick.com (it will say James Dale and have our logo) or by cash on the day of the class. No credit cards will be accepted. Please arrive 15 min before class to ensure class starts on time! Email donna@danceartsmerrick.com with any questions.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
Father
Guardian
Mother
Other
Parent
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
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade as of September:
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
College
Kind
Pre-k
Tutu Tots
Allergies (Leave blank if NONE):
Primary Doctor:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade as of September:
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
College
Kind
Pre-k
Tutu Tots
Allergies (Leave blank if NONE):
Primary Doctor:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade as of September:
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
College
Kind
Pre-k
Tutu Tots
Allergies (Leave blank if NONE):
Primary Doctor:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade as of September:
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
College
Kind
Pre-k
Tutu Tots
Allergies (Leave blank if NONE):
Primary Doctor:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade as of September:
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
College
Kind
Pre-k
Tutu Tots
Allergies (Leave blank if NONE):
Primary Doctor:
Additional Information:
Other Questions/Comments:
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