DYT Dance Collective Registration Form

Student Contact Information                               

Name *

Student's Name

Contact Email *

Student's Phone Number

Student Age *

Medical Information

Student's medical requirements (medication/allergies/special needs)

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Parent/Guardian Contact Information               

Name *

Parent/Guardian Name

Parent's Contact Email *

Parent/Guardian Phone Number *

Alternate Parent/Guardian Contact Information

Name 

Contact Email

Alternate Guardian Phone Number

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