CREATIONS On-A-Roll After School Program On a Roll web submission 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? 13 + 4 = Submit