Senior Dance Intensive
Dancer'sname:
Dancer'sname:
*
First
Last
Dancer's current age:
*
Dancer's Date of Birth:
Dancer's Date of Birth:
*
/
MM
/
DD
YYYY
Parent name:
Parent name:
*
First
Last
Parent Email:
*
Parent phone number:
Parent phone number:
*
-
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-
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Previous dance experience?
*
Previous dance experience?
Yes
No
What dance school?
*
How many years?
*
Payment method:
*
Payment method:
Interac eTransfer
** Payment by e-transfer to: melissa@themka.com.
C$
0
Total