Foundations Program

Dancer's Name

Age

Date of Birth

Parent/ Guardian name

Parent/ guardian email

Parent/ guardian phone number

Dancer email (if applicable)

Dancer phone number (if applicable)

Medical conditions

Please provide an emergency contact in addition to the parent/ guardian contact.

Emergency contact

Emergency contact phone number

TERM ONE TUITION

Coupon Code

Admin Fee

$2.00

HST

$0.26

Total

$2.26

Billing Information

Name

Credit Card

Address

Phone Number