Online Registration Form

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Child's First Name

Child's Last Name

Birth Date

(dd/mm/yyyy)

Age

Address
 (Street, Apartment, City, Postal Code)

Home Phone

Cell (optional)

E-mail

Mother's Name
Occupation (optional)
Business Phone (optional)
Father's Name
Occupation (optional)
Business Phone (optional)
Friend's Name
 (for the case of emergency)
Friend's Phone
Child's Health Card Number (optional)
Doctor's Name (optional)
Doctor's Phone (optional)
Dance Experience Yes   No
Duration of One Class (optional) 1 hour     1.5 hours
Classes per Week (optional) 1    2    3
Schedule (optional) Monday    Tuesday    Wednesday
Thursday    Friday    Saturday    Sunday
Fee per Month
Start Date (optional) (dd/mm/yyyy)      Today is: 19/11/2008
How did you find us? (optional)   

Comments (optional)

Participant’s Release Form

     I desire that my child participates in the full theatre program and in the all activities, and theatre director advised me in writing form.
     I agree that Children’s Dance Theatre Fairyland staff will not hold any responsibility for any sickness or accident in case it happens to my child.

Parent's Name