Registration Form – Cricket Performing Arts

Student Registration*

Student Name	Age	Birthdate

Address*

Street Address City State / Province / Region ZIP / Postal Code

Primary Email*

Phone*

First year enrolled at Cricket's*

Please provide year for each student registering

Student Name	First Year Enrolled

Total Years of Dance Experience*

Please provide total years of experience for each student registering

Student Name	Total Years

Style of Dance Previously Enrolled in*

Please list the style of dance your student(s) has been previously enrolled in

Dance Style

Classes of Interest*

Select all classes you would be interested in taking

Other Classes of Interest

Individual Responsible for Payments*

First Last

Contact Phone Number

Mother's Name

First Last

Mother's Phone Number (home)

Mother's Phone Number (Cell)

Father's Name

First Last

Father's Phone Number (Home)

Father's Phone Number (Cell)

Emergency Contact*

Name	Relationship	Phone (home)