Registration

REGISTRATION FORM

Please fill in required fields (if it doesn't apply please put N/A) and submit. You will be contacted for confirmation once your registration has been processed.

Dancer/Participant Information
Dancer's First Name:
*
Dancer's Last Name:
*
Date of birth:
*
Academic School Dancer Attends
*
Grade:
*

Parent/Guardian/Family Information
Mother/Guardian Information
Mother's First Name:
*
Mother's Last Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Phone:
*
E-mail address:
*
Employer:
*
Work Phone:
*
Mother's Cell Phone

Father/Guardian Information
Father's First Name:
*
Father's Last Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Phone:
*
E-mail address:
*
Employer:
*
Work Phone:
*
Father's Cell Phone

How did you hear about us?
Previous dance experience
Years

Months

Please enroll participant in the following classes:
Discipline

Instructor

Day

Time

Pertinent Medical Information
Are there any physical limitations (including all allergies) asthma previous injuries or special needs that Foothills Dance & Performing Arts Studio should be aware of?

Yes
No
If yes please describe:

Security code:
*
Do not enter anything in this field:

* indicates a required field