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Dance & Move Registration Form

Monday 29th / Tuesday 30th July.

Parent / Guardian Name *

Student / Participant Name *

Birthday

Day

Month

Year

Email*

Address

Phone *

Emergency Contact / Phone. Leave blank if same details as above.

Any health issues, i.e asthma, allergies we need to be aware of.

Photo consent

yes

no

Signature*

IMG_7796.JPG.jpg

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