JD's Fabulous Feet Dance School

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Student's Name:

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Guardian's Name:

Contact Number #1:

Contact Number #2:

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Student's Date of Birth:

Age as of Sept. 1st:

Years of Experience:

Medical Problems:

Emergency Contact Name & Number:

Check the type of discipline you wish to take:

Tap Jazz Lyrical Ballet Extra Ballet (a must for pointe students) Pointe Zumba	Combo Class (Jazz, Tap and Ballet) Musical Theatre Stretch/Strength Hip Hop Highland Variety (competitive students only)

Recreational Level 1 Competitive Level 2 Competitive

Extra Project Request (competitive students only):

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Expiration Date:

Registration Fee:

$10.00 + 0.50 (GST) = $10.50 before May 31st.

$20.00 + 1.00 (GST) = $21.00 after May 31st.