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Student:_______________________________________________
Age:________________________D.O.B_____________________
Parent(s):_______________________________________________
Address:_______________________________________________
City:_____________________________
Zip:_________________
Home phone:________________ Cell/Work:__________________
Email:______________________________
Childcare
Center:______________________________
Location:_______________________________________________
(Name of street, road or highway)
Please check program preference for your child's school.
Acceptance is subject to course availability. Call
770-831-1220 or check with your child's school for specific
programs offered there
Pre-Ballet:_____
Tap-Ballet:_____ Hip-Hop:_____
I have read and understand the information provided in
this website. I waive any
right to claim against Creative
Movement and Dance, Inc. owners, staff, and teachers
in the event of accident, injury or loss of personal
items. To review policies, click
here.
Signature:__________________________________Date:___________ |
