Miss Tanya's Expression of Dance, Inc. Online Registration

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Miss Tanya's Expression of Dance

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Additional Info

Emergency Contact Info
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Contact #1

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Contact #2

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Student #1

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Student #2 (Show-Hide Details)

Student's First Name*

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Additional Info

Student Email

T-Shirt Size

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Medications (Leave blank if NONE)

Primary Doctor

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Student Email

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Medications (Leave blank if NONE)

Primary Doctor

T-Shirt Size*

Enroll in Classes

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Student #4 (Show-Hide Details)

Student's First Name*

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Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

T-Shirt Size*

Enroll in Classes

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

T-Shirt Size*

Enroll in Classes

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Where do you live?

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Contact #1

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Contact #2

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Student #1

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Student #2 (Show-Hide Details)

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I Agree to All of the Above

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