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Student's Name *

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Middle

Last

Parent's Name *

First

Middle

Last

Names of anyone else who will be making payments towards the account:

Allergies: *

Phone #: *

Work/Emergency Phone #: *

Text #:

Eligible Discounts:

Address: *

Correct Format: Street Address City, State Abrev. Zip Code

E-mail *

Date Registered: *

MM/DD/YYYY

Dancer's Birthday *

MM/DD/YYYY

Number of years at Laura's: *

If this is your first year, fill in "0."

School:

Grade:

Where did you hear about us?

Richmond All-Star Dance Company

Yes, I am interested in auditioning for the dance company for the following year.

Teacher's Aide Program

Classes the Dancer is Interested in: (Check All That Apply)

For a complete list of descriptions or age and skill level for each class please see our "Class Descriptions" page.

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