QCPA Season 4 Registration Form

2021/2022 Season

Question Title

* 1. Student's Name

Question Title

* 2. Parent Name

Question Title

* 3. Student's Date of Birth

Question Title

* 4. Mailing Address

Question Title

* 5. Primary Phone Number

Question Title

* 6. Email Address

Question Title

* 7. Emergency Contact

Question Title

* 8. Emergency Contact Number

Question Title

* 9. Classes (Select Your Desired Classes)

Jazz

Broadway Dance

Tap

Musical Theater

Acro

Ballet

Hip Hop

Contemporary

Pre-Ballet/Jazz/Tap (ages 2-4)

Pointe

Question Title

* 10. Medical

Allergies

Will your child require any special medical attention during a normal class? (yes/no)

If yes, explain:

Question Title

* 11. Shirt Size

Child XS

Child S

Child M

Child L

Child XL

Adult XS

Adult S

Adult M

Adult L

Adult XL

Question Title

* 12. Shoe Size

Question Title

* 13. Pant Size

Child XS

Child S

Child M

Child L

Child XL

Adult XS

Adult S

Adult M

Adult L

Adult XL

Question Title

* 14. Registration Fee

New Student- $75

Returning Student-$50

QCPA Season 4 Registration Form

2021/2022 Season

Question Title

* 1. Student's Name

Question Title

* 2. Parent Name

Question Title

* 3. Student's Date of Birth

Question Title

* 4. Mailing Address

Question Title

* 5. Primary Phone Number

Question Title

* 6. Email Address

Question Title

* 7. Emergency Contact

Question Title

* 8. Emergency Contact Number

Question Title

* 9. Classes (Select Your Desired Classes)

Question Title

* 10. Medical

Question Title

* 11. Shirt Size

Question Title

* 12. Shoe Size

Question Title

* 13. Pant Size

Question Title

* 14. Registration Fee

Question Title

* 15. Please share your child's dance experience. (NEW STUDENTS ONLY)