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Student Name:
Address:
City:
State
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Zip Code
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Telephone #:
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Email:
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Name: Parent/Guardian #1
Name: Parent/Guardian #2
Please choose your preferred class day(s) and time(s):
Class Day:
and Time:
Class Day:
and Time:
Class Day:
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In case& of emergency, please notify:
Emergency telephone:
Student's age as of 9/1):
Birth Date:
Please list past experience in dance (include styles of dance and number of years)
Name of previous danceschool:
Any health or physical restrictions?
How did you hear about our school?
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Performance
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Other
From time to time we take pictures during activities. We would like your permission to use these pictures on our website, in our newsletter, or on our bulletin board. We will never reference your child by name or provide any specific information regarding your child. We also will never sell these pictures; we will use them exclusively for Denises Dance Academy's purposes.
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