Short Dance Studios Online Registration

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Welcome to the Short Dance Studios! We are excited to educate and inspire through the art of dance!

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Referral Information

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Family Information

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Home Address*

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Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

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Contact #1

Contact #1 First Name*

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Work #

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Confirm Email*

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Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

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Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

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Employer

Employer Phone

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Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School Attending*

Grade Level*

Medical Conditions

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Number of Years at Short Dance*

Other Dance Experience*

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School Attending*

Grade Level*

Medical Conditions

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Number of Years at Short Dance*

Other Dance Experience*

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School Attending*

Grade Level*

Medical Conditions

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Number of Years at Short Dance*

Other Dance Experience*

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School Attending*

Grade Level*

Medical Conditions

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Number of Years at Short Dance*

Other Dance Experience*

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School Attending*

Grade Level*

Medical Conditions

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Number of Years at Short Dance*

Other Dance Experience*

Enroll in Classes

Select Class *

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Enroll in Classes

Student #5 (Show-Hide Details)

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