Spotlight Dance Academy Online Registration

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Spotlight Dance Academy Registration Form

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Student #1

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If you need any guidance selecting classes, please contact Miss Becky at 978-996-4495 or Becky@sdawestford.com

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Student's First Name*

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Primary Doctor

If you need any guidance selecting classes, please contact Miss Becky at 978-996-4495 or Becky@sdawestford.com

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Disabilities (Leave blank if NONE)

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Primary Doctor

If you need any guidance selecting classes, please contact Miss Becky at 978-996-4495 or Becky@sdawestford.com

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Student's First Name*

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Grade Level

Disabilities (Leave blank if NONE)

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Primary Doctor

If you need any guidance selecting classes, please contact Miss Becky at 978-996-4495 or Becky@sdawestford.com

Enroll in Classes

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Student's First Name*

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T-Shirt Size

School

Grade Level

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

If you need any guidance selecting classes, please contact Miss Becky at 978-996-4495 or Becky@sdawestford.com

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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

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