kids-program(form) - Ascendant Dance Company

Student Name *

First

Last

Student DOB

What classes are you interested in?

TUESDAY | Tiny tots | 4:00 - 4:30pm
TUESDAY | Ages 7-12 | 4:30 - 5:15pm
TUESDAY | Ages 12-17 | 5:15 - 6:00pm
SATURDAY | Ages 9-12 | 11:00 - 11:45am
SATURDAY | Ages 5-8 | 12:00 - 12:45 pm

Parent full name: *

Email address: *

Phone number: *

Home address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Comments: *

Email *