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TPDC Student Registration Page
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* Indicates required question
First Name
*
(one student per e-form)
Your answer
Last Name
*
Your answer
Birthdate
*
(dd/mm/yyyy)
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Parent/Guardian
*
Your answer
Home Phone
*
Your answer
Cell Phone
*
Your answer
Email
*
Your answer
Classes
*
(Please include day+time+dance style, ie. "Tuesday, 5:00pm, Tap")
Your answer
Allergies
*
(or none if applicable)
Your answer
Emergency Contact 1
*
(Please include name, phone number and relationship to student)
Your answer
Emergency Contact 2
*
(Please include name, phone number and relationship to student)
Your answer
How did you learn about TPDC?
Your answer
Authorization of the use of students' photograph(s) taken while particIpating in activities or instruction at Turning Pointe Dance Center to be used on the studio's website or for promotional materials.
*
Yes, I give permission for my child/children's photograph(s) to be used.
No, I do not want my child/children's photograph(s) to be used.
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