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Parent and Guardian Information:

Name *
E-mail Address *
Address *
City *
State *
Zip Code *
Home Phone *
Mother's Work Phone
Father's Work Phone
Cell Phone
Emergency Contact Name *
Emergency Contact Phone Number *
How did you hear about Woodbury Dance Center? * Advertisement
family/Friend/Neighbor
Yellow Pages
Woodbury Days
Returning Student
Internet/World Wide Web
Student 1 Name *
Student 1 Age *
Student 1 Birthdate (mm/dd/yyyy) *
Student 1 School Attending
Student 1 Grade 08-09
Student 1 # of yrs of dance *
Session Dates *
Student 1 first class day choice *
Student 1 first class time choice
Student 1 first class choice *
Student 1: Are there any health issues we should be aware of?
Student 1 would like to attend dance with:
Student 2 Name
Student 2 Age
Student 2 Birthdate (mm/dd/yyyy)
Student 2 School Attending
Student 2 Grade 08-09
Student 2 # of yrs of dance
Student 2 Session Dates
Student 2 first class day choice
Student 2 first class time choice
Student 2 first class choice
Student 2: Are there any health issues we should be aware of?
Student 2 would like to attend dance with:
Student 3 Name
Student 3 Age
Student 3 Birthdate (mm/dd/yyyy)
Student 3 School Attending
Student 3 Grade 08-09
Student 3 # of yrs of dance
Student 3 Session Dates
Student 3 first class day choice
Student 3 first class time choice
Student 3 first class choice
Student 3: Are there any health issues we should be aware of?
Student 3 would like to attend dance with:

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