Jazz Registration | Tri'Une Production

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Tri'Une Dance & Fitness, Inc.

triunedancefitness@gmail.com

(219) 472-1511

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Tammi Bolden
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Jazz Registration

DANCERS INFORMATION

Dancer First Name

Dancer Last Name

Age

Birthday

Gender *

Male

Female

Parent 1 First name

Parent 1 Last name

Home Phone

Work Phone

Cell Phone

Email

Street Address

City

Street Address Line 2

State

Zip code

List all and any physical conditions and Allergies

Emergency Contact Name

Emergency Contact Address

Emergency Contact Phone

WAIVER FOR PARTICPANT AND/BY PARENT

I agree to the terms & conditions

Your Signature

Date

Thanks for Registering!

Keep in Touch

Your Email Address

Thanks for submitting!

© 2022 Tri'Une Dance and Fitness Inc.

E-Mail: triunedancefitness@gmail.com
Tel: 219-472-1511

Home
About
Classes
Tammi Bolden
Contact
Shop

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