Registration
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Welcome to J'adore Dance!
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Referral Information
How did you hear about us?
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Coupon
Exhibition
Facebook
Internet Search
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Other
Parent Magazine
Performance
Referral
Returning Family
Walk-in
Website
Referral Name
Family Information
Family Last Name
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Where do you live?
Home Address
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City
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State
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DE
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WV
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Zip
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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 #
Portal Access (your email is your login)
Email
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(Emails are kept confidential)
Confirm Email
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Portal Account Password
Confirm Portal Account Password
Contact #2
Contact #2 First Name
Last Name
How can we contact you?
Home Phone
Work #
Cell #
Email
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(Emails are kept confidential)
Confirm Email
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Student #1
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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Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #2
(Show-Hide Details)
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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Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
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Student Gender
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Female
Male
Birth Date
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Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #4
(Show-Hide Details)
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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Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Large
Child X-Small
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Add Another Student
Required Policies
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I Agree to All of the Above
Enter your Full Name
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December 22, 2024
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