Dancers First Name *

Dancers Last Name *

Date of birth *

Dancer's Age *

Parents Name *

Parents Email *

Parents Cell *

Who Is Your Friend *

Emergency Contact *

Emergency Contact Number *

Class(es) Attending *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

I give my child permission to attend Bring a Friend week at emjaez Dance Studio.

Signature *

Clear

Date *

Privacy Policy | Terms of Service