To register for Dance Fuel Classes, please fill in the information below:

Student's First Name:
Student's Last Name:

Gender

Male

Female

Birth Date

Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Month month January February March April May June July August September October November December

Year Year 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

School

Grade

Grade Pre_school One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve

Parents/Guardian

Home Phone(mom)

Work Phone

Cell Phone

Home Phone(dad)

Work Phone

Cell Phone

Address One
Address Two

City/Town

Postal Code

Email

Sitter's Name

Sitter's Phone Number

Please select 1 for your first choice and 2 for your second choice, otherwise simply leave the choice as 0. As we will contact you directly, we can verify your courses when we speak. Thanks.

Ballet	0 1 2	Acro	0 1 2	Primary Ballet/Jazz	0 1 2	Adult Jazz	0 1 2
Jazz	0 1 2	Jacro	0 1 2	Adult Tap	0 1 2	Tap	0 1 2
Lyrical/ Modern	0 1 2	Pre-Dance	0 1 2	Hip Hop	0 1 2	Musical Theatre	0 1 2
Adult Ballet	0 1 2	AC-Hop	0 1 2	Jazz-Hop	0 1 2
Competitive-classes Specify

Dance experience

1-2 yrs

3+years

Where

What is the earliest time of day during the week dancer can attend class?

Time 7:00 8:00 9:00 10:00 11:00 option value="12h">12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00

Dancer is not available on (days and times)

Health Concerns (i.e allergies):

Please provide name(s) of any siblings registered in this dance school as well:

What classes are they registered for?
How did you find out about us?:
Special requests (i.e. would like to be with a friend/sibling, no Saturday classes?)