Child's Name

Age

Date of Birth

Food Allergies

Previous Dance Experience

Parent/Guardian Name PARENT/GUARDIAN (1-Primary):

Email Address

Phone

Address

Parent/Guardian Name PARENT/GUARDIAN (2):

Email

Phone

Address CANCELLATION POLICY No refunds issued for natural, unexpected, unforeseen and uncontrollable environmental events.

Name EMERGENCY CONTACT 1):

Phone

Additional Phone

Name EMERGENCY CONTACT 2):

Phone

Additional Phone

DOCTOR NAME EMERGENCY MEDICAL CONTACT

DOCTOR PHONE

Does child have any special medical considerations?