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IMAGINE...

The Impossible For Every Child: Performing Arts Center

Class Registration

How did you hear about IMAGINE...?

Dancer Information

Dancer's First Name

Dancer's Last Name

Dancer's Birth Date

Dancer's Cell Phone Number (if applicable)

Dancer's Home Address

Dancer's Email Address (if applicable)

Any Medical Concerns?

Medications (if applicable)

Parent / Legal Guardian Contact

First name

Last name

Home address (if different from dancer)

Cell Phone Number (preferred phone)

Work Phone Number

Home Phone Number

Email Addess

Parent / Legal Guardian Contact 2

First name

Last name

Home address (if different from dancer)

Cell Phone Number (preferred phone)

Work Phone Number

Home Phone Number

Email Addess

Your registration has been submitted. You will hear from us soon!

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