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L'École de Danse Louise aimerait vous souhaiter la bienvenue.
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Referral Information
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Family Information
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Postal Code
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Primary Phone
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Additional Info
Emergency Contact Info (Not Contact #1 or #2)
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Contact #1
Contact #1 First Name
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Last Name
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How Can We Contact You?
Home Phone
Work #
Cell #
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Email
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Contact #2
Contact #2 First Name
Last Name
Type
Father
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Self
How can we contact you?
Home Phone
Work #
Cell #
Email
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Confirm Email
Student #1
Student's First Name
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Last Name
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Student Gender
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Female
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Birth Date
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Cell #
Additional Info
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Student #2
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Student #3
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T-Shirt Size
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Child Large
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Student #4
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Male
Birth Date
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Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
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Student #5
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Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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Cell #
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
School
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
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December 4, 2024
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Card Nickname
Name as it appears on card
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Address Line 1
Address Line 2
Country
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US - UNITED STATES
CA - CANADA
GB - UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
AU - AUSTRALIA
AD - ANDORRA
AE - UNITED ARAB EMIRATES
AF - AFGHANISTAN
AG - ANTIGUA AND BARBUDA
AI - ANGUILLA
AL - ALBANIA
AM - ARMENIA
AO - ANGOLA
AQ - ANTARCTICA
AR - ARGENTINA
AS - AMERICAN SAMOA
AT - AUSTRIA
AW - ARUBA
AX - ALAND ISLANDS
AZ - AZERBAIJAN
BA - BOSNIA AND HERZEGOVINA
BB - BARBADOS
BD - BANGLADESH
BE - BELGIUM
BF - BURKINA FASO
BG - BULGARIA
BH - BAHRAIN
BI - BURUNDI
BJ - BENIN
BL - SAINT BARTHELEMY
BM - BERMUDA
BN - BRUNEI DARUSSALAM
BO - BOLIVIA
BQ - BONAIRE, SINT EUSTATIUS AND SABA
BR - BRAZIL
BS - BAHAMAS
BT - BHUTAN
BV - BOUVET ISLAND
BW - BOTSWANA
BY - BELARUS
BZ - BELIZE
CC - COCOS (KEELING) ISLANDS
CD - CONGO (THE DEMOCRATIC REPUBLIC OF THE)
CF - CENTRAL AFRICAN REPUBLIC
CG - CONGO
CH - SWITZERLAND
CI - COTE D'IVOIRE
CK - COOK ISLANDS
CL - CHILE
CM - CAMEROON
CN - CHINA
CO - COLOMBIA
CR - COSTA RICA
CU - CUBA
CV - CABO VERDE
CW - CURACAO
CX - CHRISTMAS ISLAND
CY - CYPRUS
CZ - CZECH REPUBLIC
DE - GERMANY
DJ - DJIBOUTI
DK - DENMARK
DM - DOMINICA
DO - DOMINICAN REPUBLIC
DZ - ALGERIA
EC - ECUADOR
EE - ESTONIA
EG - EGYPT
EH - WESTERN SAHARA
ER - ERITREA
ES - SPAIN
ET - ETHIOPIA
FI - FINLAND
FJ - FIJI
FK - FALKLAND ISLANDS (MALVINAS)
FM - MICRONESIA, FEDERATED STATES OF
FO - FAROE ISLANDS
FR - FRANCE
GA - GABON
GD - GRENADA
GE - GEORGIA
GF - FRENCH GUIANA
GG - GUERNSEY
GH - GHANA
GI - GIBRALTAR
GL - GREENLAND
GM - GAMBIA
GN - GUINEA
GP - GUADELOUPE
GQ - EQUATORIAL GUINEA
GR - GREECE
GS - SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
GT - GUATEMALA
GU - GUAM
GW - GUINEA-BISSAU
GY - GUYANA
HK - HONG KONG
HM - HEARD ISLAND & MCDONALD ISLANDS
HN - HONDURAS
HR - CROATIA
HT - HAITI
HU - HUNGARY
ID - INDONESIA
IE - IRELAND
IL - ISRAEL
IM - ISLE OF MAN
IN - INDIA
IO - BRITISH INDIAN OCEAN TERRITORY
IQ - IRAQ
IR - IRAN, ISLAMIC REPUBLIC OF
IS - ICELAND
IT - ITALY
JE - JERSEY
JM - JAMAICA
JO - JORDAN
JP - JAPAN
KE - KENYA
KG - KYRGYZSTAN
KH - CAMBODIA
KI - KIRIBATI
KM - COMOROS
KN - SAINT KITTS AND NEVIS
KP - KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF
KR - KOREA, REPUBLIC OF
KW - KUWAIT
KY - CAYMAN ISLANDS
KZ - KAZAKHSTAN
LA - LAO PEOPLE'S DEMOCRATIC REPUBLIC
LB - LEBANON
LC - SAINT LUCIA
LI - LIECHTENSTEIN
LK - SRI LANKA
LR - LIBERIA
LS - LESOTHO
LT - LITHUANIA
LU - LUXEMBOURG
LV - LATVIA
LY - LIBYA
MA - MOROCCO
MC - MONACO
MD - MOLDOVA, REPUBLIC OF
ME - MONTENEGRO
MF - SAINT MARTIN
MG - MADAGASCAR
MH - MARSHALL ISLANDS
MK - NORTH MACEDONIA
ML - MALI
MM - MYANMAR
MN - MONGOLIA
MO - MACAO
MP - NORTHERN MARIANA ISLANDS
MQ - MARTINIQUE
MR - MAURITANIA
MS - MONTSERRAT
MT - MALTA
MU - MAURITIUS
MV - MALDIVES
MW - MALAWI
MX - MEXICO
MY - MALAYSIA
MZ - MOZAMBIQUE
NA - NAMIBIA
NC - NEW CALEDONIA
NE - NIGER
NF - NORFOLK ISLAND
NG - NIGERIA
NI - NICARAGUA
NL - NETHERLANDS
NO - NORWAY
NP - NEPAL
NR - NAURU
NU - NIUE
NZ - NEW ZEALAND
OM - OMAN
PA - PANAMA
PE - PERU
PF - FRENCH POLYNESIA
PG - PAPUA NEW GUINEA
PH - PHILIPPINES
PK - PAKISTAN
PL - POLAND
PM - SAINT PIERRE AND MIQUELON
PN - PITCAIRN
PR - PUERTO RICO
PS - STATE OF PALESTINE
PT - PORTUGAL
PW - PALAU
PY - PARAGUAY
QA - QATAR
RE - REUNION
RO - ROMANIA
RS - SERBIA
RU - RUSSIAN FEDERATION
RW - RWANDA
SA - SAUDI ARABIA
SB - SOLOMON ISLANDS
SC - SEYCHELLES
SD - SUDAN
SE - SWEDEN
SG - SINGAPORE
SH - SAINT HELENA, ASCENSION AND TRISTAN DA CUNHA
SI - SLOVENIA
SJ - SVALBARD AND JAN MAYEN ISLANDS
SK - SLOVAKIA (Slovak Republic)
SL - SIERRA LEONE
SM - SAN MARINO
SN - SENEGAL
SO - SOMALIA
SR - SURINAME
SS - SOUTH SUDAN
ST - SAO TOME AND PRINCIPE
SV - EL SALVADOR
SX - SINT MAARTEN
SY - SYRIAN ARAB REPUBLIC
SZ - ESWATINI
TC - TURKS AND CAICOS ISLANDS
TD - CHAD
TF - FRENCH SOUTHERN TERRITORIES
TG - TOGO
TH - THAILAND
TJ - TAJIKISTAN
TK - TOKELAU
TL - TIMOR-LESTE
TM - TURKMENISTAN
TN - TUNISIA
TO - TONGA
TR - TURKEY
TT - TRINIDAD AND TOBAGO
TV - TUVALU
TW - TAIWAN, PROVINCE OF CHINA
TZ - TANZANIA, UNITED REPUBLIC OF
UA - UKRAINE
UG - UGANDA
UM - UNITED STATES MINOR OUTLYING ISLANDS
UY - URUGUAY
UZ - UZBEKISTAN
VA - HOLY SEE
VC - SAINT VINCENT AND THE GRENADINES
VE - VENEZUELA (BOLIVARIAN REPUBLIC OF)
VG - VIRGIN ISLANDS (BRITISH)
VI - VIRGIN ISLANDS (U.S.)
VN - VIET NAM
VU - VANUATU
WF - WALLIS AND FUTUNA ISLANDS
WS - SAMOA
YE - YEMEN
YT - MAYOTTE
ZA - SOUTH AFRICA
ZM - ZAMBIA
ZW - ZIMBABWE
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