Premier Dance Center Registration Form

Student information

Select One :
Single Student:
Family

Gender:
Students Name :

Age :

DOB : (format YYYY-MM-DD)

Grade :

School Attending/Occupation :

Student Telephone :

Student Address w/City and State:

Student Email :

T-shirt Size:
How did you here about us? If Other :

Dance Experience? If Yes, How Long and Dance Type :

Favorite Candy Bar :

Favorite Color :

Parents and Emergency Contact Information Parent/Guardian Name :

Parent/Guardian Cell :

Parent/Guardian Home :

Parent/Guardian Email :

Emergency Contact :

Emergency Number :

Class Enrollment Information

1st Dance Class 1st Dance Class Name :

Day :

Time :

2nd Dance Class 2nd Dance Class Name :

Day :

Time :

3rd Dance Class 3rd Dance Class Name :

Day :

Time :

Conditions

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