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Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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Alternate Phone (optional)

(###)

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Alternate Email (optional)

Dancer Name

First Name

Last Name

Dancer Date of Birth

YYYY

Dancer Phone (optional)

(###)

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Dancer Email (optional)

Previous Dance Experience

Preferred Class Location

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