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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

Parent or Guardian Name*

Cell Phone*

Email*

Other Parent or Guardian Name

Parent's Occupation

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