|
2008/2009 Registration Form
Student Name ____________________________________________ Age ____ Date of Birth ________ Address_________________________________________________ Home Phone ________________ Email: _________________________________________________________________ School District ______________________ Grade Entering ______ School _______________________ Parent/Legal Guardian(s): _______________________________ Phone __________________ _______________________________ Phone ________________ Emergency Contact(s): ______________________________ Phone __________________ ______________________________ Phone__________________ Permission to administer first aid/CPR Yes No Permission to transport Yes No Circle the appropriate interest: Tutoring Dance Classes Coaching MUCAI Dance Group RADS Club Physical Training Circle classes interested in: ____ Pre-School Ballet _____ Contemporary ______ Group Conditioning ____ Pre-School Tap _____ Tap ______ Personal Training ____ Ballet _____ Phunky Jazz ____ Pointe _____ Classical Jazz
List a personal strength: _________________________________________________________________ List a personal weakness: ______________________________________________________________ Special Needs, Health Concerns, Injuries in the last 2 years: ____________________________________________________________________________________ ____________________________________________________________________________________ Tutoring Registrants: List academic strengths: ________________________________________________________________ ________________________________________________________________ List academic weaknesses: _____________________________________________________________ _____________________________________________________________ Dance Registrants: Years of experience: Ballet______ Pointe______ Tap_____ Jazz______ Contemporary_______ Theatre Dance ______ Hip Hop______ Performance _______
Fitness Registrants: Level of Physical Exercise: Very Active Somewhat Active Not Actively Exercising
Parent Signature _________________________________ Date _________________________ Students Signature (if over 18): _____________________________________ Date ________________ |