Academy of World Dance n Arts Registration Form

Please fill out this form and your information will be sent to our office. To complete your registration, please come to our office, request a policy form and submit payment. Thank You! Welcome to the World Dance n Arts Family!

Student Full Name Age Birthdate School Grade Student 2 Full Name Student 2 Age Student 2 Birthdate Student 2 School Student 2 Grade Primary Contact Phone Cell Phone Parent 1 Full Name Parent 1 Phone Parent 2 Full Name Parent 2 Phone E-mail Address Home Address City Zip Code Emergency Contact Name Emergency Contact Phone Any important medical concerns that we should know about? Insurance Company Name Policy Number Previous Experience Classes you are interested in? Days Preferred? Class Times Preffered? How did you hear about us?