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Tri'Une Dance & Fitness, Inc.
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Tammi Bolden
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Tap Dance 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
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Date
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Thanks for Registering!
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