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* 1. Dancer's Name:

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* 2. Parent's Name:

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* 3. Address:

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* 4. Email:

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* 5. Phone Number:

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* 6. Student's Birthday:

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* 7. What class(es) would you like to enroll in?

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* 8. Do you have dance experience? If so, please explain. (For new students only.)

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* 9. Does student have any medical conditions? If so, please explain.

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