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Dancer's Name

First Name

Last Name

Studio Location:

I would like to join:

Contact Email Address

Dancer's Phone Number (if applicable)

Dancer's Date of Birth

Any Health/Allergy Concerns?

Additional Dancer's Name

Additional Dancer's Date of Birth

Any Health/Allergy Concerns?

I would like to join this additional class:

Classes marked with "*" meet twice per week

Parent/Guardian 1 Name (if dancer is under 18)

First Name

Last Name

Parent/Guardian 1 Email Address

Parent/Guardian 1 Phone Number

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Any previous clogging experience?

How did you hear about us?