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Fundamentals and recreational registration form
Student's Name
*
Parent's Name(s)
*
Birth Year
*
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989 or earlier
Birth Month
*
January
February
March
April
May
June
July
August
September
October
November
December
Birth Day
*
1
2
3
4
5
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31
Gender
*
Female
Male
Address
*
City
*
Postal Code
*
Home Phone #
*
Cell Phone #
*
Cell Phone #
*
Email
*
*
Indicates required field
How Did You Hear About Us?
*
Facebook
Flyer
Poster
Referral
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Other
I am a...
*
New Student
Returning Student
Years Experience
*
Name of Previous Dance Studio
*
2020-2021 Pre Dance Classes
*
Dance With Me 18 months - 3 years
Early Birds 3-4 Years
Session
*
N/A
Fall
Fall/Winter
Winter
Spring
Preferred Class Time
*
N/A
Saturdays
Weekday Evening
Weekday Morning
2020-2021 4-8 Years Classes
*
Tiny Stars (4-5 Years)
Mini Stars (5-6 Years)
Mini Acro (5-6 Years)
Pre Primary Ballet (6-8 Years)
Shooting Stars (6-8 Years)
Primary/Level 1 Acro (6-8 years)
Hip Hop Kids (5-7 Years)
Preferred Class Time
*
N/A
Weekday Evenings
Saturdays
2020-2021 Recreational Classes
*
Tap
Jazz
Ballet
Acrobatics
Hip Hop
Musical Theater
*NEW* Lyrical/Contemporary ages 13+ (must be in ballet)
2020-2021 Adult Classes
*
Beginner/Intermediate Tap
Medical Conditions/Allergies
*
I understand that mine or my child's spot is not held in their session program until the
full
payment has been made. I have also read the registration handbook and understand the studio policies.
I understand that my child's spot is not held in their seasonal class(es) until the registration fee has been paid. I have read the registration handbook and understand the studio policies.
I have read the Session Registration Requirements
*
Yes
N/A
I have read and understand the Seasonal Registration requirements
*
Yes
N/A
By checking this box I allow my child to dance at Pointflex Dance Company. I release the staff of Pointflex Dance Company of any liability in the event of an accident or illness during my child's class. I release photos of my child taken at Pointflex Dance Company or competitions and realize that they may be used for promotional material
I have read the Release of Liability
*
Yes
Signature Authorization (Full Name)
*
I agree to receiving marketing and promotional materials
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