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Directory Results for 8 WEEK REGISTRATION 20122013 Dancer s First Name: Last Name: DOB: # years of dance: Care Card #: Medical Info: Mothers Name: Home Phone: Cell Phone: Fathers Name: Home Phone: Cell Phone: Bill to Name (if necessary): Home Phone: Cell to 8 WEEK REGISTRATION 20132014 Dancer s Name: Age: Gender: DOB: Medical Info: Parent/Guardian #1: Home Phone:( ) Cell Phone:( ) Parent/Guardian #2: Home Phone:( ) Cell Phone:( ) Parent/Guardian Email Address (Print Clearly): OFFICE USE

8 WEEK REGISTRATION 20122013 Dancer s First Name: Last Name: DOB: # years of dance: Care Card #: Medical Info: Mothers Name: Home Phone: Cell Phone: Fathers Name: Home Phone: Cell Phone: Bill to Name (if necessary): Home Phone: Cell
8 WEEK REGISTRATION 20132014 Dancer s Name: Age: Gender: DOB: Medical Info: Parent/Guardian #1: Home Phone:( ) Cell Phone:( ) Parent/Guardian #2: Home Phone:( ) Cell Phone:( ) Parent/Guardian Email Address (Print Clearly): OFFICE USE