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Registration
Form
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Registration Form: Name:______________________________ Age (DOB):__________________________ Address :____________________________________________________________ __________________________________ Email(s):__________________________ Phone:______________________________ Emergency #:_______________________ Classes / Times you are Registering for: 1._______________________/__________ 2._______________________/__________ 3._______________________/__________→ Dance experience, if any: __________________________________ __________________________________ Both Parents Names & Signature: (Print, Sign, & Date) ( signifies agreement to policies, Emergency Medical treatment if needed and release of liability from “Reflections School of Dance”) ____________________________________ Please include Non-Refundable $20 Registration Fee with form. (+ $5 for each additional family member)
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