Class Registration

Dance Class Registration Form

Student Information

Student's First name

Student's Last Name

Street Address

City/State/Zip

Email (for minors, please give Parent/Guardian's email)

Cell Phone Number (for minors, please give Parent/Guardian's cell phone number)

Age

Sex

Male

Female

Past Dance Experience

Do you/your child have any special needs or medical conditions we should be aware of?

For Minors

Parent/Guardian's Name

Child's Birthday/Date of Birth

Child's Grade In School

Child's Shirt Size

Child's Current Age

Name of School

Child's Pants Size

Alternate Phone Number for Parent/Guardian (Optional)

Emergency Information

Additional Emergency Contact Name (Optional)

Emergency Contact's Phone

Emergency Contact's Relationship to Student

Primary Care Physician's Name/Practice

Primary Care Physician's Phone Number

Terms & Conditions

By checking the box below, I consent for myself/my child to participate in dance classes and associated ministry events offered by VH Dance and/or Tabernacle Church Dance Ministry. I realize I must also sign a VHDance Liability Waiver, Policy Statement, and Media Release Form prior to my/my child's first class.

I agree to the terms & conditions as specified above.

Your registration is not considered complete until your tuition payment is received.