U Can Danz! Dance Company Online Registration

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U Can Danz! Dance Company ~ Registration Form

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Referral Information

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Family Information

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Contact #1

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Type*

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Contact #2

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Work #

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Student #1

Student's First Name*

Last Name*

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Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

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Student #2 (Show-Hide Details)

Student's First Name*

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Additional Info

Student Email

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

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Primary Doctor

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student Email

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Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

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Student #5 (Show-Hide Details)

Student's First Name*

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Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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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)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

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Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

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Questions or Concerns

Payment Information

eCheck/Bank Draft

Required Policies

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