Prophecy School of the Arts

::: REGISTRATION

STUDENT INFO
Student's Name:
Age:
DOB:	(ex. mm/dd/yyyy)
Pertinent Medical Conditions/Allergies:
Current Medications:
Address:
City/State/Zip:
Home Phone:
Cell Phone:
Previous dance experience:	Number of yrs: Style of Dance:
Other gymnastic/dance related experience:
MAIN CONTACT EMAIL ADDRESS (parent or student):
Alternate E-mail Address:
PARENT/GUARDIAN INFO
Parent/Guardian Name:
Home Phone:
Cell Phone:
Work Phone:
Address (if different):
City/State/Zip:
Emergency contact other than above:
Phone:
Alternate Phone:
Registering For:
1st class 2nd class 3rd class
Sizing Information: (If necessary, will be used when placing orders)
Street Shoe Size: Leotard Size: Adult Child \| Small Medium Large Tights Size: Adult Child \| Small Medium Large