Junior August Dance Intensive
Student's name:
Student's name:
*
First
Last
Student's current age:
*
Student's Date of Birth:
Student's Date of Birth:
*
/
MM
/
DD
YYYY
Parent/Guardian's Name:
Parent/Guardian's Name:
*
First
Last
Parent/Guardian's Phone Number:
Parent/Guardian's Phone Number:
*
-
###
-
###
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Parent/Guardian's Email:
*
Previous dance experience?
*
Previous dance experience?
Yes
No
What dance school?
*
** Payment by e-transfer to: melissa@themka.com.