Studio C Dance

Registration Form

Dancer’s name: ________________________________________________________

Date of Birth: __________________________________________________________

Allergies: _____________________________________________________________

Special Needs/Physical Limitations: _________________________________________

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Mailing address:________________________________________________________

Postal Code: _______________________ E-mail Address:________________________

Mother’s name: __________________________________________________________

Telephone: Home: _____________________________ Work: __________________

Father’s name: ___________________________________________________________

Telephone: Home: _____________________________ Work: ___________________

Alternate contact during dance class (babysitter/ Grandparents/ relatives):

Name: ____________________________ Relationship: _________________________

Telephone: ________________________________