Student's Name *

First Name

Last Name

Student's Date of Birth

MM

DD

YYYY

Dance Styles *

Ballet

Ballet Exams

Acro

Jazz

Lyrical/Contemporary

Musical Theatre

Hip Hop

Tap

Performance Teams

Solos

Duos/Trios

Parent/Guardian's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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