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* denotes a required field

Student Name*

Student's Age/Grade*

Home Address*

Home Phone*

Second Student Name

Second Student's Age/Grade

Primary Contact Name*

Cell Phone*

Email*

Other Parent or Guardian Name

Cell Phone

Email

Please let us know if your child has any health issues we should be aware of

Which classes are you registering for?*

Photo and video permission: By checking this box, I understand that photographs or videos may be taken of students (not including the name) during class and / or performances. I agree that the school for publicity purposes may use such images.*
YesNo

Parent's Digital Signature*

Date* (DD/MM/YYYY)

Notes or Comment