Shawn Terenzi's Academy of Dance - Fall Registration Form

Please fill in all fields. Fields marked with a * are required.
	Student First Name	*
	Student Last Name	*
	Date of Birth	*
	Address	*
	City	*
	State	*
	Zip	*
	Grade
	Guardian Name
	Home Phone
	Cell Phone
	Email Address	*
	Alternate Email Address	*
	List Medical Conditions or Limitations
	Previous Training
	How did you hear about our school	*
	Emergency Contact Person	*
	Emergency Phone	*
	I agree to all policies and accept the release waiver	*
	Class 1
	Class 2
	Class 3
	Class 4
	Class 5
	Class 6
	Class 7
	Class 8
	Class 9
	Class 10