Parent or guardian name *

First Name

Last Name

Phone *

(###)

###

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Dancer name *

First Name

Last Name

Dancer date of birth *

MM

DD

YYYY

Emergency contact phone number

if different than primary phone number

(###)

###

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Checkbox *

I have read and agree to the Conditions of Registration

I understand that the information I have submitted will not be shared with a third party without my permission