Matilda Jr.

Parent/Guardian First & Last Name *

First Name

Last Name

Parent/Guardian Phone Number *

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2nd Parent/Guardian First & Last Name

First Name

Last Name

2nd Parent/Guardian Phone Number

(###)

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Address *

Please enter your home address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

First Student's First & Last Name *

First Name

Last Name

First Student's Birthday *

MM

DD

YYYY

Second Student's First & Last Name

First Name

Last Name

Second Student's Birthday

MM

DD

YYYY

Third Student's First & Last Name

First Name

Last Name

Third Student's Birthday

MM

DD

YYYY

Fourth Student's First & Last Name

First Name

Last Name

Fourth Student's Birthday

MM

DD

YYYY

Emergency Contact's First & Last Name *

First Name

Last Name

Emergency Contact's Phone Number *

(###)

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Social Media *

New this year! We’d like to expand our social media presence. Part of that includes celebrating our students’ achievements. Please select one of the following options below:

Post would include first name only with any photos as well as a tag for the student (if applicable) and/or parent. No other identifying information would be posted. For example: (Picture of Suzie) – Happy Birthday, Suzie! We hope you have a great birthday. @awesomesuziedancer

Post would include first name only with a photo, but no tags of the student and/or parent. No other identifying information would be provided. For example: (Picture of Suzie) – Happy Birthday, Suzie! We hope you have a great birthday!

Posts would only include group pictures of the student. No name or any other identifying information would be posted. For example: (Group picture of students in their recital costumes) Our dancers are getting excited to hit the stage in these fabulous costumes!

No social media images of the student.

By checking here I acknowledge that I have read and will follow the studio policies. *

I Agree