Registration Form

Student First Name:*
Student Last Name:*
Date of Birth: (Format: mm/dd/yyyy)
Mother / Guardian Name:
Father / Guardian Name:
 
Residential Address:
(continued):
City:
State:
Zip Code:
 
Home Phone:
Work Phone:
Best Time to Call:
Emergency Phone:
E-mail Address:*
 
 
School Name:
Grade:
School Hours:
 
Illnesses and/or Injuries:
Previous Training:
 
How did you learn of Cheshire Dance Centre?







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